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The  Public  Health  Committee 


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THL  NLW  YORK  ACADEMY 
OF  MLDICINL 

A  Survey  of  Its  Actwities  During  Five  Years  of  Work 

1911-1916 


17  West  Forty -Third  Street 
New  York  City 


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The  Public  Health  Committee 

of 

THL  NLW  YORK  ACADLMY 
OF  MEDICINE. 

A  Survey  of  Its  Activities  During  Five  Years  of  Work 

1911-1916 


17  West  Forty-Third  Street 
New  York  City 


TABLL  OF  CONTENTS 


Membership  of  the  Public  Health  Committee,  1916 1 

Foreword 3-4 

Chapter  I. — The  Organization  of  the  Committee 5-8 

Chapter  II.— Hospitals 9-20 

Chapter  III.— Protection  of  the  Health  of  Children 21-33 

Chapter  IV.— Vital  Statistics 34-37 

Chapter  V. — Improvement  of  I^iving  and  Working  Conditions 38-55 

Chapter  VI.— Medical,  Public  Health,  Dental  and  Nursing  Education  56-63 

Chapter  VII. — The  Care  of  the  Mentally  Defective,   the  Delinquent 

and  the  Aged 64-69 

Chapter  VIII.— Out-Patient  Clinics 70-74 

Chapter  IX.— Health  Protection  of  the  Port  of  New  York 75-80 

Chapter  X. — Miscellaneous  Activities  and  Reports 81-89 

Chapter  XI. — Municipal  Budget 90-94 

Chapter  XII.— I^egislation 95-102 

Index , 103-106 


Membership  of  the  Public  Health  Committee,   1916 


Charles  I^oomis 
JAMKS   Alexander 

T.  Passmore  Berens,  M.D. 
Nathan  E.  Brill,  M.D. 
Robert  J.  Carlisle,  M.D. 
Floyd  M.  Grand  all,  M.D. 
G.  A.  Friedman,  M.D. 
Lewis  Fox  Frissell,  M.D. 
Arpad  G.  Gerster,  M.D. 

S.    S.    GOLDWATER,    M.D. 

Thomas  W.  Hastings,  M.D 
George  B. 


Dana,  M.D.,  Chairman 
Miller,    M.D.,    Secretary 

L.  Emmett  Holt,  M.D. 
Abraham  Jacobi,  M.D. 
Howard  Lilienthal,  M.D. 
William G,  MacCallum,  M.D. 
Bernard  Sachs,  M.D. 
Thomas  W.  Salmon,  M.D. 
W.  Gilman  Thompson,  M.D. 
Philip  Van  Ingen,  M.D. 
Karl  M.  Vogel,  M.D. 
Wallace,  M.D. 


E.  H.  Lewinski-Corwin,  Ph.D.,  Executive  Secretary 


Digitized  by  tine  Internet  Arciiive 

in  2010  witii  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/publichealthcommOOnewy 


FORLWORD 


The  present  Report  contains  a  summary  of  the  activities  of  the 
Public  Health  Committee  of  the  New  York  Academy  of  Medicine 
during  the  first  five  years  of  its  existence.  In  this  period  of  time 
the  Committee  has  come  into  contact  with  so  many  problems  con- 
cerning the  health  of  the  City  and  has  been  called  upon  to  express 
its  opinion  on  so  many  vital  matters,  that  it  has  been  thought 
advisable  to  bring  all  the  reports,  suggestions  and  recommenda- 
tions together,  in  the  hope  that  in  this  readily  available  form  they 
might  be  of  use  to  those  interested  in  public  health  problems. 

The  material  has  been  classified  under  twelve  topical  headings, 
covering  the  main  divisions  of  the  field  of  public  health  endeavor. 
Some  problems  which  were  of  more  immediate  urgency  have  occu- 
pied the  attention  of  the  Committee  more  than  others,  and  a  great 
deal  of  time  and  attention  was  devoted  in  bringing  about  certain 
administrative  changes  or  reforms,  notably  that  of  the  transfer  of 
the  quarantine  station  at  the  Port  of  New  York  from  State  to  Federal 
control.  The  contagious  disease  hospitals  in  this  City,  child  hygiene, 
vital  statistics  and  health  publicity,  and  the  budgets  of  the  Depart- 
ments of  Health,  Bellevue  and  Allied  Hospitals  and  Public  Charities 
are  matters  which  have  claimed  particular  attention  on  the  part  of 
the  Committee. 

The  Committee  acknowledges  its  deep  appreciation  of  the 
services  rendered  by  former  members  who  are  no  longer  upon 
the  roll  of  membership.  Dr.  John  H.  Huddleston,  whose  untimely 
death  last  year  was  a  great  loss  to  the  entire  community,  was  par- 
ticularly unsparing  in  his  devotion  to  the  interests  of  the  Commit- 
tee which  owes  much  to  his  ability,  tact  and  wise  counsel.  The 
Committee   also  wishes  to   acknowledge  the   hearty  co-operation  it 


has  received  in  its  work  on  the  part  of  the  Commissioners  and  em- 
ployees of  the  several  City  departments  with  which  it  has  dealt,  and 
of  the  various  civic  organizations  and  other  associations  interested 
in  public  health  work. 

The  Committee  takes  this  occasion  to  acknowledge  the  gene- 
rosity of  the  contributors  to  its  financial  support,  Mrs.  E.  H, 
Harriman  furnished  the  fund  which  first  established  the  work  of 
the  Committee  and  has  been  very  gracious  in  support  ever  since. 
In  addition,  the  following  persons  have  contributed  to  this  work 
during  the  past  five  years:  Mr.  George  Blumenthal,  Dr.  Charles 
ly.  Dana,  Mr.  Philip  J.  Goodhart,  Mr.  Edward  S.  Harkness,  Dr. 
E.  Emmett  Holt,  Dr.  Abraham  Jacobi,  Dr.  Walter  B.  James,  Mr. 
Meyer  H.  Eehman,  Mr.  Adolph  Lewisohn,  Mr.  Isaac  N.  Seligman, 
Dr.  Philip  Van  Ingen,  and  Mr.  Charles  A.  Wimpfheimer.  Two 
anonymous  contributions  have  also  been  received,  one  through  Dr. 
Nathan  E.  Brill  and  the  other  through  Dr.  T.  Passmore  Berens. 


THE  ORGANIZATION  OF  THE,  COMMITTLL 


The  Code  of  Medical  Ethics,  adopted  in  1847  ^7  the  American 
Medical  Association,  recognizes  physicians  as  conservators  of  pub- 
lic health  and  declares  that  "it  is  a  delicate  and  noble  task,  by  the 
judicious  application  of  Public  Hygiene  to  prevent  disease  and 
lengthen  life,  and  thus  to  increase  the  productive  industry,  and 
without  assuming  the  office  of  moral  and  religious  teaching,  to 
aid  the  civilization  of  an  entire  people." 

Early  in  its  history  the  Academy  of  Medicine  stated  in  its 
constitution  that  one  of  its  four  objects  was  the  promotion  of  public 
health;  and  in  1852,  following  the  precept  already  quoted,  it  created 
a  standing  Committee  on  Public  Health.  In  1858  a  Section  on 
Public  Health  and  Legal  Medicine  was  established,  which  existed 
until  April  26,  191 1  when  at  its  own  request  it  was  abolished  by 
the  Council  of  the  Academy  and  replaced  by  a  Committee  on  Public 
Health.  Prior  to  that  a  Committee  on  Hospitals  was  appointed 
by  the  President  of  the  Academy  on  March  25,  1908*  and  on  May 
25,  1910  another  Committee  was  appointed  to  represent  the  Acad- 
emy at  the  budget  hearings  before  the  Board  of  Estimate  and  Ap- 
portionment. These  two  Committees  were  merged  into  one  on  May 
I,  191 1  and  on  October  22,  191 1  the  Committee  on  Pubhc  Health 
was  merged  with  the  joint  Committee  on  Hospitals  and  Munici- 
pal Budget  into  the  Public  Health,  Hospital  and  Budget  Committee 
with  the  following  membership :  Dr.  Charles  L.  Dana,  Chairman, 
Dr.  James  Alex.  Miller,  Secretary,  Dr.  Herman  M.  Biggs,  Dr.  John 
Winters  Brannan,  Dr.  Algernon  T.  Bristow,  Dr.  Robert  J.  Carlisle, 
Dr.  Arpad  G.  Gerster,  Dr.  S.  S.  Goldwater,  Dr.  L.  Emmett  Holt, 
Dr.  John  H.  Huddleston,  Dr.  Abraham  Jacobi,  Dr.  Theodore  C. 


NOTE: — Under  the  Chairmanship  of  Dr.  Charles  L.  Dana  the  Committee  on  Hos- 
pitals did  important  work  for  over  two  years,  until  the  organization  of  the  larger 
Committee. 


Janeway,  Dr.  Samuel  Lloyd,  Dr.  W.  Gilman  Thompson  and  Dr. 
Linsly  R.  Williams.  Several  changes  in  the  membership  have 
been  made  since  then.  In  1912  Dr.  Haven  Emerson  and  Dr.  Philip 
Van  Ingen  were  elected  to  the  membership  of  the  Committee ;  dur- 
ing 1913  Dr.  Frank  S.  Meara,  Dr.  James  Ewing,  Dr.  Egbert  Le 
Fevre  and  Dr.  Frederic  S.  Lee  served  on  the  Committee ;  and  in 
1914  Dr.  Edward  L.  Keyes,  Jr.,  was  a  member.  Death  has  removed 
Dr.  Algernon  T.  Bristow,  Dr.  Egbert  Le  Fevre  and  Dr.  John  H. 
Huddleston.  In  the  early  stages  of  the  Committee  Dr.  Herman 
M.  Biggs  and  Dr.  John  Winters  Brannan,  both  of  whom  were 
officially  connected  with  City  Departments,  resigned.  Upon  his 
appointment  as  Deputy  Commissioner  of  the  State  Department 
of  Health,  Dr.  Linsly  R.  Williams  also  resigned.  In  1914  Dr. 
S.  S.  Goldwater  became  Commissioner  of  the  Department  of  Health 
of  New  York  City  and  Dr.  Haven  Emerson  his  Deputy,  and  both 
severed  their  connections  with  the  Committee.  Since  his  resigna- 
tion from  the  Commissionership,  Dr.  Goldwater  has  again  joined 
the  Committee.  E.  H.  Lewinski-Corwin,  Ph.D.  has  been  Executive 
Secretary  since  May  i,  191 1.  On  January  7,  191 5,  at  its  annual 
meeting,  the  Academy  voted  to  change  the  name  of  the  Committee 
to  the  Public  Health  Committee  and  defined  its  status  in  the  follow- 
ing resolution  : 

RESOLVED :  That  the  President  be  authorized  to  appoint  each  year 
a  committee  to  be  known  as  the  Public  Health  Committee,  and  to  fill  such 
vacancies  as  may  occur  in  it,  or  make  such  additions  as  may  seem  best. 
This  Committee  shall  be  authorized  to  co-operate  with  public  health  ac- 
tivities and  to  make  studies  of,  and  issue  statements  upon  matters  pertain- 
ing to  public  health  and  hospitals ;  but  such  statements  shall  not  be  issued 
until  approved  by  three-fourths  of  the  Committee  and  by  the  President  of 
the  Academy  of  Medicine.  Subject  to  these  provisions  and  in  pursuance  of 
these  objects  the  Committee  is  authorized  to  appear  before  any  committee, 
board,  legislature  or  other  body,  in  order  to  make  statements  and  express 
opinions  on  matters  relating  to  public  health  and  hospitals. 

The  membership  of  the  Committee  at  the  present  time  is  as 
follows :  Dr.  Charles  Loomis  Dana,  Chairman,  Dr.  James  Alexander 
Miller,  Secretary,  Dr.  T.  Passmore  Berens,  Dr.  Nathan  E.  Brill, 
Dr.  Robert  J.  Carlisle,  Dr.  Floyd  M.  Crandall,  Dr.  G.  A.  Friedman, 
Dr.  Lewis  Fox  Frissell,  Dr.  Arpad  G.  Gerster,  Dr.  S.  S.  Goldwater, 
Dr.  Thomas  W.  Hastings,  Dr.  L.  Emmett  Holt,  Dr.  Abraham 
Jacobi,  Dr.   Howard  Lilienthal,  Dr.  William  G.   MacCallum,   Dr. 


Bernard  Sachs,  Dr.  Thomas  W.  Salmon,  Dr.  W.  Oilman  Thompson, 
Dr.  Philip  Van  Ingen,  Dr.  Karl  M.  Vogel  and  Dr.  George  B. 
Wallace. 

The  scope  of  the  Committee's  work  has  been  very  large,  and 
during  the  five  years  of  its  existence  it  has  come  into  contact  with 
almost  every  phase  of  public  health  endeavor  in  this  City.  The 
program  of  work  as  formulated  by  the  Committee  in  191 1,  wide  as 
it  was,  failed  to  include  all  the  fields  into  which  the  actual  activities 
of  the  Committee  have  been  carried. 


THE  SCOPE  OF  THE  WORK  OF  THE  COMMITTEE  AS 
OUTLINED  IN  ITS  ORIGINAL  PROGRAM. 

I.     Public  Health 

(a)  To  maintain  a  bureau  for  the  collection  of  facts  in  regard 
to  public  health,  sanitation,  and  hygiene. 

(b)  To  endeavor  to  establish  an  active  co-operation  with  all  pub- 
lic health  activities  in  the  City. 

(c)  To  keep  the  medical  profession  advised  of  current  public 
health  conditions. 

(d)  To  render  to  the  public  authorities  and  to  the  community  at 
large  an  authoritative  medical  opinion  on  public  health  mat- 
ters ;  this  to  include  conferences  with  officials  of  various  City 
Departments,  the  holding  of  public  meetings,  the  giving  of 
lectures,  the  distribution  of  literature,  and  other  methods  of 
publicity. 

(e)  To  undertake  and  suggest  special  researches  looking  to  the 
solution  of  vital  public  health  problems,  such  as  an  investiga- 
tion of  industrial  diseases,  etc. 

(f)  To  make  a  comparative  study  of  methods  and  results  of 
public  health  activities  in  other  cities,  both  in  this  country 
and  abroad. 

{g)  To  co-operate  with  the  Library  Committee  in  maintaining 
the  literature  in  the  Academy  Library  upon  the  subjects  of 
public  health,  sanitation,  and  hygiene  in  a  high  degree  of 
efficiency. 


II.     Municipal  Budget 

va)  To  utilize  facts  obtained  by  the  study  of  public  health  and 
hospital  conditions  for  practical  application  in  the  preparation 
of   the   annual   municipal  budget. 

(b)  To  assist  actively  the  various  departments  of  the  City  govern- 
ment which  relate  to  public  health  and  hospitals  in  the 
preparation  of  their  tentative  budgets. 

(c)  To  take  an  active  part  in  the  budget  hearings  before  the 
Board  of  Estimate  and  Apportionment. 

III.     Hospitals 

\^z)  To  make  a  study  of  hospital  and  dispensary  conditions  in 
New  York  City,  including  public  health  and  private  institu- 
tions in  all  the  boroughs,  this  study  to  be  made  from  a  stand- 
point of : 

1.  Construction 

2.  Equipment 

3.  Administration 

4.  Medical  efficiency 

(b)  To  plan  for  the  future  development  of  hospitals  and  dispen- 
saries according  to  the  distribution  of  population,  and  to 
further  the  efforts  already  being  made  to  raise  the  standards 
of  dispensary  work. 

(c)  To  undertake  a  comparative  study  of  hospital  and  dispensary 
conditions  in  other  cities,  both  in  this  country  and  abroad. 

(d)  To  co-operate  with  the  Library  Committee  in  establishing 
and  maintaining  a  section  in  the  Library  of  the  Academy  for 
the  collection  of  all  forms  of  literature  relating  to  hospitals 
and  dispensaries. 

Rarely  has  a  written  program  been  more  faithfully  carried 
out,  as  the  following  pages,  outlining  the  various  activities  of  the 
Committee  during  the  past  five  years  will  demonstrate.  In  addition, 
it  will  be  noted  that  the  sphere  of  action  of  the  Committee  has 
widened  materially  by  a  proportionate  development,  until,  through 
it,  the  Academy  of  Medicine  may  truly  be  said  to  be  a  potent  force 
in  the  public  health  movement,  so  that  at  the  present  time  it  more 
nearly  approaches  the  ideal  expressed  in  the  Code  of  Medical 
Ethics  in  1847,  than  at  any  previous  period  of  its  history. 


II 


HOSPITALS 


CONTAGIOUS  DISEASE  HOSPITALS  OF  THE  CITY. 

The  first  matter  which  claimed  the  attention  of  the  Committee 
was  the  contagious  disease  hospital  situation  in  this  City.  During 
the  summer  of  191 1  an  intensive  investigation  was  carried  on  with 
the  co-operation  of  Dr.  Lederle,  then  Commissioner  of  Health  of 
the  City  of  New  York.  It  comprised  a  study  of  details  of  organ- 
ization, construction  and  administration.  The  hospital  facilities 
were  studied  in  connection  with  the  hospital  population  and  its 
character;  statistics  o£  transfers  of  patients  from  borough  of 
residence  to  other  boroughs,  their  condition  on  arrival  at  the  hos- 
pitals, were  compiled  and  classified;  age  and  sex  statistics  for  each 
disease  were  grouped  separately;  the  degree  of  overcrowding  was 
analyzed  by  weeks  and  presented  graphically  on  charts.  The  ques- 
tion of  cross  infections  was  thoroughly  studied  in  all  its  bearings. 
Medical  reports  and  records  were  examined.  Comparative  mortal- 
ity rates  in  hospitals  here  and  abroad,  and  in  the  City  in  general, 
were  compiled  and  analyzed.  The  results  of  the  work  of  the  hos- 
pitals for  a  number  of  years  were  carefully  compiled  and  studied. 
A  statistical  study  of  the  prevalence  of  the  contagious  diseases  in 
the  City  revealed  the  coincidence  in  the  prevalence  of  measles  and 
scarlet  fever  and  their  epidemic  nature  in  comparison  with  the 
constancy  of  diphtheria  for  a  number  of  years.  The  endemic  nature 
of  this  disease,  as  well  as  the  large  number  of  fatalities  resulting 
from  it,  in  view  of  the  fact  that  the  cause  of  the  disease  and  the 
mode  of  transmission  are  known,  was  emphasized  and  recom- 
mended for  a  special  study. 

The  report  on  Contagious  Disease  Hospitals,  and  the  Commit- 


tee's  numerous  recommendations  with  regard  to  them  were  sub- 
mitted to  the  Department  of  Health  and  to  the  Board  of  Estimate 
and  Apportionment.  A  copy  of  the  recommendations  is  herewith 
appended.  Many  of  the  recommendations  were  adopted  by  the 
Department.  Others,  although  considered  very  desirable,  could  not 
be  adopted  at  the  time  because  of  the  lack  of  funds  for  putting 
them  into  practice. 

RECOMMENDATIONS     AND     SUGGESTIONS    REGARDING    CON- 
TAGIOUS DISEASE  HOSPITALS. 
Presented  to  the  Department  of  Health  in  igii. 

New  Hospitals. 

1.  Two  new  hospitals  for  contagious  diseases,  especially  for  Scarlet 
Fever  and  Diphtheria,  should  be  provided  for  in  the  immediate  future. 
One  in  the  Borough  of  the  Bronx  and  one  in  Queens.  These  hospitals 
should  be  located  near  congested  centers  or  those  which  are  apt  to  become 
more  thickly  populated. 

2.  The  majority  of  beds  in  these  hospitals  should  be  for  scarlet  fever 
patients;  a  comparatively  small  number  for  diphtheria  and  for  measles. 

3.  A  special  hospital  for  measles  should  be  constructed  in  the  Borough 
of  Manhattan. 

4.  Hospitals  should  be  so  located  that  the  long  ambulance  rides  which 
at  present  often  occur,  should  be  eliminated. 

The  possibiHty  of  substituting  automobiles  for  the  horse  ambulance  is 
recommended. 

Details  of  Hospital  Construction. 

1.  The  wards  in  these  hospitals  should  be  small  with  a  maximum 
capacity  of  ten  patients,  with  facilities  for  dividing  the  ward  into  alcoves  by 
glass  partitions  half  the  height  of  the  room. 

2.  Sufficient  accommodations  should  be  provided  for  observation  wards 
in  each  hospital. 

3.  There  should  be  in  addition  a  number  of  small  rooms  for  the  segre- 
gation of  cases  of  mixed  infection,  doubtful  cases  and  cases  with  compli- 
cations. 

4.  Convalescent  patients  should  be  separated  from  those  who  arc 
actively  and  acutely  ill. 

5.  Children's  wards  for  acute  illness  should  be  restricted  for  the  use 
of  children  only,  and  the  beds  should  be  of  such  size  as  to  make  doubling 
up  impossible. 

10 


6.  There  should  be  a  large  number  of  water  closets  and  linen  closets 
situated  conveniently  to  the  wards. 

7.  Every  ward  should  have  a  small  treatment  room  adjoining. 

8.  Elevators  in  the  hospitals  should  be  provided  with  safety  devices 
which  would  prevent  the  starting  of  them  unless  all  the  shaft-doors  are 
closed. 


Quarantine  and   Sanitary  Regulations. 

1.  Existing  rules  should  be  more  strictly  enforced. 

2.  Ward  maids  should  not  be  allowed  to  come  in  direct  contact  with 
the  patients,  and  convalescent  patients  should  not  be  permitted  to  enter  the 
diet  kitchens. 

3.  The  precautions  already  taken  against  vaginitis  are  to  be  commended 
and  should  be  extended  as  rapidly  as  possible. 

4.  It  is  suggested  that  smears  should  be  taken  by  one  or  two  especially 
instructed  and  responsible  persons,  either  physicians  or  nurses,  and  that  they 
should  be  specially  trained  in  the  most  effective  method  of  obtaining  the 
smears. 

5.  Cases  with  purulent  discharge  from  the  nose,  throat,  or  ear  should 
be  treated  in  special  pavilions  and  provisions  made  for  the  retention  of 
these  cases  until  danger  from  them  has  ceased. 

Nursing. 

1.  Provisions  should  immediately  be  made  for  an  increased  number 
of  nurses  with  increased  salaries,  so  that  they  may  be  of  a  higher  grade 
of  women. 

2.  These  nurses  should  be  retained  on  the  payroll  for  the  entire  year, 
arrangements  being  made  for  their  transfer  to  other  divisions  of  the  Health 
Department  when  they  are  not  needed  during  the  light  months  of  con- 
tagious diseases. 

3.  There  should  be  at  least  one  nurse  to  every  ten  acute  cases  during 
the  day  and  to  every  fifteen  such  cases  during  the  night. 

4.  Special  nurses  should  be  available  for  very  sick  patients. 

5.  It  is  suggested  that  the  desirability  of  employing  specially  trained 
nurses  for  some  of  the  ambulance  duty  be  considered. 

Medical  Care. 

I.  The  recent  change  in  the  visiting  medical  staff  at  the  Willard  Parker 
Hospital  is  highly  recommended.  It  is  urged  that  every  facility  be  given 
for  the  proper  study  and  medical  care  of  the  patients,  especially  by  prompt 
attentiofi  to  requisitions  for  medical  equipment. 

11 


2.  That  the  time  of  the  internes  be  so  arranged  that  they  can  give 
a  large  proportion  of  it  to  ward  duty  rather  than  to  ambulance  duty. 

3.  That  the  internes  should  be  impressed  with  the  value  of  the  clinical 
and  laboratory  studies  to  a  much  larger  extent  than  at  present,  instead  of 
the  concentrated  interest  in  the  practice  of  intubation,  and  that  proper 
laboratory  facilities  be  supplied  for  that  purpose. 

4.  A  Medical  Board  similar  to  that  existing  at  Willard  Parker  should 
be  established  at  the  Kingston  Avenue  Hospital. 

After  Care. 

1.  All  cases  discharged  from  the  hospitals  should  be  followed  up  in 
their  homes  by  visiting  nurses  to  make  sure  of  their  complete  recovery,  to 
provide  for  country  convalescent  care  when  necessary,  and  to  discover  when 
possible  secondary  cases. 

2.  A  social  service  department  should  be  organized  at  each  hospital  for 
this  purpose. 

3.  The  possibility  of  providing  country  convalescent  branch  hospitals 
which  relieve  congestion  in  the  acute  service,  should  be  considered. 

Special  Problems. 

1.  The  high  mortality  in  the  hospitals  from  measles  as  compared  with 
the  same  disease  in  the  home  is  very  striking.  We  would  recommend  that 
a  careful  study  be  instituted  to  ascertain  the  causes  of  this  mortality,  and 
to  obviate  it  if  possible.  It  has  been  suggested  that  cases  of  measles  should 
never  be  sent  to  hospitals  excepting  when  absolutely  necessary  because  of 
the  environment  in  the  home,  for  the  reason  that  measles  in  an  institution 
always  becomes  a  more  serious  disease.  Should  this  be  the  case,  the  ap- 
pointment of  special  nurses  by  the  Department  to  care  for  measles  in  the 
homes  under  the  direction  of  the  Department  of  Health  should  be  care- 
fully considered.  Also  in  the  hospital,  special  care  against  over-crowding 
or  close  contact  with  other  patients  should  be  taken  in  the  case  of  measles, 
by  introduction  of  glass  partitions  in  the  wards. 

2.  The  persistently  constant  percentage  of  morbidity  of  diphtheria  dur- 
ing the  last  five  years  is  worthy  of  note.  This  disease  seems  less  influenced 
by  epidemics  than  the  other  contagious  diseases,  and  inasmuch  as  the  bac- 
terial cause  of  infection  and  the  method  of  transmission  are  well  recognized, 
it  would  appear  as  though  a  special  study  of  this  disease  might  lead  to 
fruitful  results  in  the  diminution  of  its  prevalence. 


12 


NEW    CONTAGIOUS    DISEASE    HOSPITALS    FOR    THE 
BOROUGHS   OF  BRONX   AND   QUEENS. 

The  studies  made  revealed  the  urgent  need  of  additional  hos- 
pital facilities  in  the  Boroughs  of  Bronx  and  Queens.  The  Com- 
mittee urged  the  appropriation  of  funds  for  these  two  institutions 
on  the  Board  of  Estimate  and  Apportionment.  The  money  was 
appropriated,  but  difficulties  were  encountered  when  plans  were 
being  drawn  for  the  erection  of  these  hospitals  on  the  sites  owned 
by  the  Department  of  Health  because  of  the  opposition  of  the 
neighboring  real  estate  interests,  particularly  in  the  Bronx,  to  the 
erection  of  a  contagious  disease  hospital  near  their  properties.  The 
Committee  then  pubHshed  a  pamphlet  entitled,  "Argument  for  a 
Contagious  Disease  Hospital  in  the  Bronx,"  which  emphasized  the 
availibility  of  the  site  owned  by  the  Department  of  Health  and 
argued  against  the  placing  of  the  new  hospital  on  North  Brother 
Island.  At  the  same  time  the  Committee  emphasized  the  fact  that 
a  hospital  for  diphtheria,  measles  and  scarlet  fever  is  not  a  danger 
to  the  neighborhood ;  that  the  theory  that  these  diseases  can  be 
transmitted  through  the  air  to  persons  in  the  vicinity  is  obsolete; 
and  that  the  prejudice  against  a  properly  equipped  and  admin- 
istered contagious  disease  hospital  as  a  danger  to  the  neighborhood 
has  ceased  to  exist  in  many  foreign  cities  and  is  without  scientific 
basis.  The  existence  of  an  unfounded  prejudice,  however,  was 
allowed  to  thwart  progress  toward  meeting  a  well  recognized  need, 
and  the  hospital  in  the  Bronx  has  not  yet  been  constructed  although 
the  new  site  selected  is  free  from  opposition  on  the  part  of  the  real 
estate  interests. 

The  present  as  well  as  the  immediate  future  needs  of  the  Bor- 
ough of  the  Bronx  call  for  a  hospital,  the  size  of  which  should  be 
considerably  larger  than  it  would  be  possible  to  build  with  the  ap- 
propriation of  $125,000.  Unless  an  adequate  plant  is  constructed 
it  will  be  impossible  to  administer  the  institution  economically,  and„ 
what  is  more  important,  the  medical  service  will  of  necessity  be 
divided  between  the  new  hospital  and  North  Brother  Island,  which 
was  pointed  out  by  the  Committee  to  be  a  most  undesirable  pro- 
cedure,  as   the    Island    is    needed    for   the    isolation    of   numerous 


13 


cases  of  advanced  tuberculosis  and  venereal  diseases  which  are  of 
particular  danger  to  the  community. 

ARGUMENT  FOR  A  CONTAGIOUS  DISEASE  HOSPITAL  IN  THE 

BRONX. 

Prepared  by   the  New  York  Academy  of  Medicine   Committee   on  Public 

Health,  Hospitals  and  Budget,  in  June,  1912,  printed  and  distributed 

among  various  civic  and  public  health  agencies  of  the  city. 

Number  of  Cases  of  Contagious  Diseases. 

By  the  Federal  Census  of  1910,  the  Borough  of  Bronx  is  credited  with 
a  population  of  430,942,  or  with  about  one  tenth  of  the  entire  population 
of  Greater  New  York. 

The  Reports  of  contagious  diseases  made  to  the  Department  of  Health 
in  1910  and  191 1  furnish  the  following  figures,  indicating  the  prevalence  of 
the  three  common  contagious  diseases  per  1000  of  population  in  Greater 
New  York,  and  in  the  Bronx: 

Greater  New  York  Bronx 

1910  1911  1910  1911 

Diphtheria    3-53  2.7  3.86  3.0 

Scarlet    Fever    3.94  3.1  S.16  3.4 

Measles    7.36  5.1  11.36  5.9 

The  share  originating  in  the  Borough  of  Bronx  is  somewhat  in  excess 
of  its  population  ratio,  the  birth  rate  of  the  Bronx  being  high  in  comparison 
with  the  birth  rates  of  other  Boroughs. 

Number  Percent,  of 

in  number  in 

Bronx  Greater  New  York 

1910  191 I  1910  1911 

Diphtheria    1696         1499  10  11 

Scarlet    Fever    2264  1663  12  10 

Measles    4988         2879  14  1 1 

Disposition  of  Cases. 

Many  of  these  cases  are  obliged  to  go  to  the  contagious  disease  hos- 
pitals, and  as  there  is  no  such  hospital  in  the  Bronx,  with  the  exception  of 
one  consisting  of  three  wards  on  North  Brother  Island,  almost  all  the 
Bronx  Patients  are  sent  either  to  Willard  Parker  Hospital,  at  the  foot  of 
East  i6th  Street,  Manhattan,  or  to  Kingston  Avenue  Hospital  in  Brooklyn. 


14 


Number  of  Patients  from  the  Bronx. 


At 

Diphtheria 

Scarlet 
Fever 

Measles 

other 
Cases 

Percentage  of 
patients  coming 
from  the  Bronx 

Willard  Parker  Hospital 

Kingston  Avenue  Hospital... 

155 

218 

191 

21 

9.26 
7.00 

During  the  period  from  January  i,  1911  to  May  i,  1912,  the  number  of 
diphtheria  cases  removed  from  the  Bronx  to  the  Willard  Parker  Hospital 
was  2044,  or  9.6  per  cent,  of  all  the  diphtheria  cases  treated  in  the  Hospital ; 
the  number  of  Bronx  scarlet  fever  cases  at  the  Hospital  being  2779,  or  10.9 
per  cent,  of  the  total  cases  treated. 

The  necessity  of  this  disposition  of  cases  must  be  considered  as  un- 
fortunate. The  long  ambulance  ride,  amounting  in  some  instances  to  eighteen 
miles,  has  been  shown  to  be  exhausting  to  many  and  fatal  to  some.  Cases 
are  recorded  which  did  not  survive  24  hours  after  they  had  been  subjected 
to  this  experience. 

Furthermore,  Willard  Parker  and  Kingston  Avenue  Hospitals  are 
crowded  to  a  dangerous  point  during  the  months  of  the  greatest  prevalence 
of  contagious  disease,  that  is,  from  December  to  May.  Additional  hospital 
accommodation  for  contagious  disease  is,  therefore,  a  serious  need. 

Appropriation  for  the  New  Contagious   Disease  Hospitals. 

A  study  of  the  hospital  care  for  contagious  diseases  in  New  York  was 
made  in  191 1,  by  The  New  York  Academy  of  Medicine  Committee  on  Public 
Health,  Hospitals,  and  Budget,  and  the  need  of  additional  contagious  disease 
hospitals  so  revealed  was  presented  to  the  Board  of  Estimate  and  Appor- 
tionment, following  which  an  appropriation  of  $250,000  was  immediately 
made  for  the  construction  of  two  contagious  disease  hospitals,  one  in  the 
Borough  of  Bronx,  and  one  in  the  Borough  of  Queens. 

Opposition  of  Real  Estate  Owners. 

The  City  Department  of  Health  has  owned  for  the  last  ten  years  two 
sites,  one  in  the  Bronx,  and  one  in  Queens.  These  sites  are  well  adapted 
for  the  location  of  contagious  disease  hospitals,  both  in  the  character  and 
area  of  the  site,  and  in  their  positions  with  reference  to  their  respective 
Boroughs.  As  soon  as  the  money  for  the  construction  of  new  hospitals 
was  appropriated,  the  Department  of  Health  asked  the  Corporate  Stock 
Budget  Committee  to  be  allowed  to  utilize  the  sites  for  that  purpose.  Im- 
mediately a  protest  was  made  by  the  neighboring  real  estate  owners  on  the 
ground  that  their  property  would  lose  in  value  because  of  popular  preju- 
dice  against   the   neighborhood   of   contagious    disease   hospitals.     A    public 


15 


hearing  on  the  matter  was  held  in  the  City  Hall  in  December,  191 1,  at 
which  the  protestants  received  some  assurance  that  the  sites  under  consid- 
eration would  not  be  used  for  contagious  disease  hospitals,  and  a  commit- 
tee of  the  residents  of  the  Bronx  was  appointed  to  find  another  suitable 
site  in  the  Bronx.  In  spite  of  statements  then  made  that  another  site 
could  be  found  within  a  very  short  time,  the  committee  did  not  report  until 
after  several  weeks,  and  then  recommended  as  a  site  for  a  Contagious 
Disease  Hospital  for  the  Bronx,  North  Brother  Island,  owned  by  the  City, 
and  controlled  by  the  Department  of  Health  since  1871. 

North  Brother  Island. 

The  New  York  Academy  of  Medicine  Committee  on  Public  Health, 
Hospitals  and  the  Budget,  is  opposed  to  the  use  of  North  Brother  Island 
as  a  contagious  Disease  Hospital,  for  the  following  reasons : 

/.    Need  of  this  Island  for  other  purposes. 

(i)  A  need  of  the  City,  now  well  recognized,  partly  met  and  of 
increasing  urgency,  is  for  a  hospital  for  compulsory  detention  of  certain 
cases  of  tuberculosis.  An  island  furnishes  much  the  most  available  site 
for  such  a  hospital,  and  it  has  been  for  several  years,  and  now  is  the 
policy  of  the  City  to  use  North  Brother  Island  for  this  purpose.  With 
this  intention  new  tuberculosis  pavilions  have  been  built  and  others  are  in 
the  process  of  construction.  It  seems  probable  that  before  many  years 
practically  the  whole  of  the  island  will  be  needed  for  this  class  of  cases. 

(2)  In  the  meantime  a  new  hospital  for  venereal  diseases,  authorized 
last  year,  is  to  be  placed  there. 

(3)  The  present  buildings,  the  extensions  planned  for  the  immediate 
future,  and  the  pavilions  for  smallpox  and  for  certain  unusual  infectious 
diseases,  which  should  be  taken  care  of  there,  so  take  up  the  island  area 
that  it  would  be  difficult  to  place  effectively  the  number  of  pavilions  neces- 
sary to  accommodate  the  measles,  scarlet  fever  and  diphtheria  cases  from 
the  Bronx. 

II.    Disadvantages  of  an  Island  for  Contagious  Diseases. 

(i)  The  transfer  to  a  hospital  of  cases  of  measles,  scarlet  fever  and 
diphtheria,  in  their  early  febrile  stages  is  attended  with  risks  which  should 
be  minimized  in  every  way  possible. 

(2)  For  the  use  of  an  island  for  such  cases  there  should  be  supplied 
a  completely  equipped  reception  hospital  on  the  mainland,  ferryboats,  each 
large  enough  to  carry  an  ambulance,  the  necessary  docks  and  piers,  and  a 
service  of  frequent  trips  during  the  entire  twenty-four  hours.  This  is 
necessary  for  the  parents  of  the  children  as  well  as  for  the  children.  The 
expense    of    the    installation    of    a    proper    system    for    an    acute    children's 

16 


service  would  be  exceedingly  large,  and  would  involve  the  acquirement  of 
water-front  property  on  the  mainland. 

(3)  The  use  of  an  island  for  chronic  adult  cases  of  infection  such 
as  syphilis  and  tuberculosis  does  not  make  the  demand  for  rapid,  well 
protected  and  frequent  transportation  involved  in  its  use  for  acute  cases  of 
infection  in  children.  The  present  transportation  to  North  Brother  Island 
may  be  called  adequate  for  its  chronic  cases. 

///.    Need  of  a  hospital  near  the  future  centre  of  population. 

The  population  of  the  Bronx  is  increasing  rapidly,  and  the  occupied 
sections  cannot  extend  in  other  than  a  northerly  direction.  The  new  sub- 
way extensions  which  are  planned  to  supply  future  demands  will  materially 
help  in  their  production.  The  population  centre  of  the  Borough  is  from 
year  to  year  moving  northeast.  A  hospital  which  will  serve  the  future 
needs  of  the  population  best,  should  be  located  on  the  line  of  anticipated 
growth. 

IV.    Availability  of  Proposed  Site. 

The  site  now  owned  and  recommended  by  the  Health  Department  is 
opposite  the  Westchester  station  of  the  N.  Y.,  N.  H.  &  H.  R.  R.  Co.,  and  a 
few  blocks  away  from  the  projected  extension  of  the  subway.  It  is  appar- 
ently conveniently  placed  with  reference  to  the  needs  of  the  Bronx,  and 
should  not  be  abandoned  by  the  City  unless  an  equally  good  substitute  can 
be  immediately  found.  It  should  be  noted  too  that  the  purchase  of  any  new 
site  would  undoubtedly  be  rendered  difficult  by  the  same  objections  of 
neighboring  real  estate  owners,  as  are  now  raised  against  the  desired  utiliza- 
tion of  this  property  of  the  City. 

The  New  York  Academy  of  Medicine  Committee  on  Public  Health, 
Hospitals  and  Budget,  would  emphasize  at  this  time  that  a  hospital  for 
diphtheria,  measles  and  scarlet  fever,  is  not  a  danger  to  the  neighborhood. 
The  theory  that  these  diseases  can  be  transmitted  through  the  air  to  persons 
in  the  vicinity  is  obsolete.  The  prejudice  against  contagious  disease  hospitals, 
properly  equipped  and  administered,  as  sources  of  danger  to  the  neighbor- 
ing residents  has  ceased  to  exist  in  many  foreign  cities,  and  is  without 
scientific  basis.  The  existence  of  an  unfounded  prejudice  should  not  be 
regarded  as  a  reason  against  the  provision  of  a  necessity  for  a  whole  com- 
munity. 


In  view  of  the  above  considerations,  we  respectfully  urge  that  the 
Board  of  Estimate  and  Apportionment  take  active  and  immediate  steps  to 
erect  a  contagious  disease  hospital  in  the  borough  of  the  Bronx,  and  that 
the  site  now  owned  by  the  City  be  used  for  this  purpose  unless  another  one 
that  is  equally  desirable  can  be  immediately  secured. 


17 


CONSOLIDATION    OF    MUNICIPAL   HOSPITALS. 

The  proposed  charter  changes  during  Mayor  Gaynor's  admin- 
istration, in  so  far  as  they  related  to  city  hospitals,  were  studied  with 
a  great  deal  of  care.  The  Committee  actively  opposed  the  contem- 
plated substitution  of  a  Department  of  Hospitals  administered  by 
a  single  paid  commissioner  for  the  efficient  and  unpaid  Board  of 
Trustees  of  Bellevue  and  Allied  Hospitals.  The  Committee  pointed 
out  the  need  of  the  consolidation  into  one  department  of  all  the 
City  Hospitals,  including  the  Tuberculosis  Sanitorium  at  Otisville, 
but  excluding  the  hospitals  of  the  Department  of  Health,  because 
of  the  special  police  powers  exercised  by  the  Board  of  Health  in 
cases  of  contagious  disease.  The  Committee  also  recommended 
that  the  powers  and  duties  of  the  Board  of  Ambulance  Service  and 
of  the  Board  of  Inebriety  be  transferred  to  the  Department  of 
Hospitals  and  that  these  two  boards  be  abolished. 

THE  HOSPITAL  SITUATION  IN  THE  LOWER  PART  OF 

MANHATTAN. 

In  the  fall  of  1912  the  Committee  made  a  study  of  the  need 
of  additional  hospital  accommodations  in  the  lower  part  of  Man- 
hattan. In  this  connection  the  House  of  Relief  and  the  Volunteer 
Hospital  were  visited.  The  statistics  of  cases  treated  in  these  in- 
stitutions were  studied  and  information  was  obtained  from  the 
Board  of  Ambulance  Service  relative  to  the  distribution  of  ambul- 
ance calls  during  the  preceding  two  years.  On  the  basis  of  this 
investigation  a  report  was  prepared  showing  that  there  was  no  need 
of  an  additional  general  hospital  in  the  lower  part  of  Manhattan. 
The  Committee  suggested  the  establishment  of  a  few  first  aid 
stations  to  give  relief  in  emergency  cases  which  occurred  in  the 
congested  parts  of  the  district,  pending  the  arrival  of  an  ambulance. 

A  MUNICIPAL  HOSPITAL  FOR  CHILDREN. 

The  urgent  need  for  proper  hospital  provision  for  children 
has  been  well  recognized  in  this  City  for  some  time  past.  In  19 13 
the  Committee  was  called  upon  by  the  State  Charities  Aid  Associa- 
tion to  express  an  opinion  as  to  the  advisability  of  establishing  a 

18 


large  children's  hospital  on  Blackwell's  Island.  The  Committee  con- 
sidered the  matter  very  carefully  and  expressed  a  unanimous  opin- 
ion against  such  a  plan  for  taking  care  of  the  sick  children  of  the 
City.  It  was  pointed  out  that  separate  children's  services  at  the 
general  hospitals  are  preferable,  provided  such  services  are  con- 
stituted as  distinct  departments  with  a  single  head  and  continuous 
medical  service. 


CHILDREN'S     PAVILION     AT     THE     METROPOLITAN 

HOSPITAL. 

At  the  request  of  Mr.  John  A.  Kingsbury,  Commissioner  of 
the  Department  of  Public  Charities  of  the  City  of  New  York,  in 
the  latter  part  of  19 14  the  Committee  made  a  study  of  his  plan  for 
transferring  the  mentally  normal  children  from  Randall's  Island 
to  a  Special  Pavilion  recently  constructed,  in  connection  with  the 
Metropolitan  Hospital  on  Blackwell's  Island.  After  having  made 
a  thorough  study  of  the  plan  and  having  visited  both  Randall's  and 
Blackwell's  Islands,  the  Committee  approved  of  the  plan  under  the 
following   conditions : 

1.  That  the  transfer  of  the  mentally  normal  children  from 
Randall's  Island  be  considered  a  temporary  measure;  it  should  not 
imply  that  the  policy  of  the  Department  of  Charities  will  be  to 
convert  Randall's  Island  permanently  into  an  institution  for  the 
mentally  defective. 

2.  That  this  plan  be  not  carried  out  until  the  money  for  the 
new  tuberculosis  pavilions  at  Sea  View  Hospital  has  been  definitely 
released  and  their  construction  consequently  assured. 

3.  That  the  number  of  beds  available  at  the  present  time  for 
tuberculosis  patients  at  the  Metropolitan  Hospital  be  not  diminished. 

4.  That  a  suitable  detention  and  observation  ward  be  pro- 
vided for  all  children  on  admission. 

5.  That  the  plan  include  definite  assurances  that  a  compe- 
tent and  expert  medical  board  of  visiting  physicians  will  be  appoint- 
ed to  this  new  children's  service,  and  also  that  proper  and  adequate 
care  of  the  surgical  cases  will  be  assured. 

6.  That  the  medical  board  at  present  in  charge  of  the  men- 

19 


tally  normal  children  be  continued  at  Randall's  Island,  so  that  the 
methods  of  medical  supervision  for  the  mental  defectives  can  be 
re-organized  in  such  a  way  as  to  provide  systematic  general  medi- 
cal care  for  these  children. 

This  Report  was  submitted  to  the  Commissioner  of  Public 
Charities  and  all  of  the  above  conditions  were  observed.  Referring 
to  the  first  condition  in  a  recent  letter  to  the  Committee,  Mr. 
Henry  C.  Wright,  First  Deputy  Commissioner,  writes  that  "all  of 
the  normal  children  were  taken  away  from  Randall's  Island,  and 
whether  or  not  it  may  be  necessary  or  advisable  to  change  this 
policy  will  be  determined  by  further  experiment." 


20 


Ill 


PROTLCTION  OF  THE  HEALTH  OF  CHILDREN 


HEALTH  CONDITIONS  IN  PUBLIC  SCHOOLS. 

The  matter  of  the  health  conditions  in  the  pubHc  schools  and 
the  methods  of  medical  inspection  in  the  schools  have  been  very 
carefully  studied  by  the  Committee.  A  report  was  prepared  and 
pubHshed  in  the  New  York  Medical  Record  of  August  31,  1912. 
It  dealt  with  such  problems  as  the  efficiency  of  the  nurses'  and 
physicians'  work,  the  proper  division  of  work  among  them,  the 
exclusion  of  contagious  disease  cases,  the  frequency  and  thorough- 
ness of  medical  examinations,  the  ratio  of  medical  inspectors  and 
nurses  to  school  children,  home  visits  and  school  and  dispensary 
co-operation. 

The  report  contained  a  number  of  constructive  recommenda- 
tions, some  of  which  are  given  herewith : 

1.  That  in  addition  to  their  regular  work,  the  school  inspec- 
tors should  make  a  routine  inspection  of  every  class  at  the  begin- 
ning of  each  term,  in  order  that  the  control  of  tuberculosis  and 
some  contagious  eye  and  skin  diseases  may  be  made  more  rigid. 

2.  That  for  every  2500  children  there  should  be  one  nurse, 
and  for  every  7500  children  one  medical  inspector;  and  that  the 
budget  of  the  Division  of  Child  Hygiene  be  based  upon  the  census 
of  school  population. 

3.  That  physical  examinations  be  made  more  thorough  and 
more  frequently;  that  the  children,  or  at  least  the  boys  at  first,  be 
stripped  to  the  waist  at  physical  examinations ;  and  that  a  child 
be  examined  when  it  enters  school  and  then  every  two  years. 

4.  That  in  the  nurses'  work  special  emphasis  be  laid  on  the 

21 


follow  up  work ;  and  that  the  burden  of  clerical  work  be  lightened. 

5.  That  the  salaries  of  nurses  be  graded.  Instead  of  receiv- 
ing a  uniform  wage  of  $900  a  year,  the  initial  wage  should  be  $800, 
after  a  certain  period  of  time  increased  to  $900  and  then  again  to 
$1000.    The  gradation  will  act  as  a  stimulus  to  efficient  work. 

6.  That  medical  inspection  be  instituted  in  the  high  schools. 

7.  That  the  City  appropriate  money  for  the  enlargement  of 
the  force  of  the  Division  of  Child  Hygiene,  so  as  to  enable  them 
to  undertake  the  inspection  of  parochial  and  other  free  schools. 

8.  That  the  medical  practitioners  and  the  dispensaries  be 
impressed  with  the  importance  of  this  work  to  the  community  and 
be  urged  to  co-operate;  and  that  provision  for  dental  clinics  be 
made,  this  being  done  if  possible  through  the  existing  dispensaries. 

9.  That  in  the  Department  of  Education  the  responsibility 
for  the  conditions  affecting  the  health  of  the  school  child  be  con- 
centrated. An  improved  organization  should  be  worked  out,  which 
would  bring  under  the  jurisdiction  of  one  committee  the  sanitary 
conditions  in  schools,  the  instruction  of  children  in  physical  train- 
ing and  personal  hygiene,  the  segregation  and  treatment  of  back- 
ward and  mentally  defective  children,  and  co-operation  with  the 
Department  of  Health,  which  is  an  indispensable  condition  for  suc- 
cessful medical  work  in  the  schools. 

10.  That  a  larger  corps  of  physicians  be  employed  by  the 
Department  of  Education  in  order  that  facilities  for  the  examina- 
tion and  study  of  backward  children  may  be  extended. 


EYE  DEFECTS  IN  SCHOOL  CHILDREN. 

At  the  request  of  the  Department  of  Health  the  Committee 
has  prepared  a  report  on  the  relation  of  seating  and  lighting  facili- 
ties in  school  rooms  to  the  incidence  of  myopia  among  school 
children.  The  report  showed  that  conditions  in  many  of  our  public 
schools  are  unsatisfactory  and  conductive  to  the  impairment  of 
vision.  The  report  was  submitted  to  the  Department  of  Health 
in  September,  1914,  with  the  recommendation  that  a  careful  study 
of  this  question  be  made  by  the  Department  of  Health  and  the  De- 
partment of  Education. 


22 


REPORT    OF    THE    SUB-COMMITTEE    ON    MYOPIA    IN    SCHOOL 

CHILDREN  TO  THE  PUBLIC  HEALTH  COMMITTEE  OF  THE 

NEW  YORK  ACADEMY   OF  MEDICINE. 

The  standard  works  on  Diseases  of  the  Eye  bear  out  the  statement 
made  concerning  the  casual  relation  between  poor  nutrition,  unsatisfactory 
school  environment,  spinal  curvature  and  visual  defects. 

S.  D.  Risley  in  Norris  and  Oliver's  System  of  Diseases  of  the  Eye, 
states  "Observation  has  shown  that  a  considerable  percentage  of  those  who 
enter  upon  the  educational  process  in  apparently  good  health  soon  manifest 
impaired  general  vigor,  acquire  distorted  spines  and  develop  nearsight." 

The  same  author  states  the  results  of  an  analysis  of  more  than  200,000 
published  examinations  of  the  eyes  of  students,  as  follows :  "Stated  in 
general  terms  ...  it  was  shown  .  .  .  that  myopia,  extremely  rare 
or  entirely  absent  before  the  beginning  of  the  educational  process  was  found 
to  advance  steadily  in  percentage  with  the  progress  of  the  pupils  in  the 
school." 

Erismann's  figures  for  St.  Petersburg  show  13.6  per  cent,  of  myopia 
in  the  1st  grade,  and  42.8  per  cent,  in  the  8th. 

Risley  in  Philadelphia,  found  4.27  per  cent,  of  myopia  at  8.5  years 
and  19.33  at  17.5- 

Cohn  in  Germany  showed  1.4  per  cent,  in  5  village  schools  as  against 
26.2  per  cent,  in  2  gymnasia,  and  59.5  per  cent,  in  the  University. 

Loring  and  Derby  in  New  York  found  7  per  cent,  in  the  primary 
schools  and  27  per  cent,  in  the  normal  schools. 

In  speaking  of  the  causes  of  the  development  of  myopia  Risley  says, 
"The  myopic  eye  results  only  under  the  stress  of  those  employments  which 
require  the  protracted  use  of  the  eyes  at  near  work." 

The  general  concensus  of  opinion  among  all  authorities  seems  to  be 
that  bad  illumination,  improper  position  in  using  the  eyes,  and  all  forms  of 
eyestrain  are  factors  of  importance  in  the  development  of  myopia. 

The  Committee  has  visited  three  public  schools  in  Manhattan  during 
school  hours.  A  moderately  dull  day  was  selected  in  order  to  estimate  the 
lighting  under  medium  conditions.  The  three  schools  selected  were  No.  9 
at  82nd  Street  and  West  End  Avenue,  No.  166  at  89th  Street  between 
Columbus  and  Amsterdam  Avenues,  and  No.  54  at  104th  Street  and  Ams- 
terdam Avenue.  These  represented  the  old  style,  modern  and  intermediate 
types  of  building.  The  class  rooms  of  grades  two  to  five  inclusive,  were 
visited  in  all  three  schools  and  the  upper  grades  in  one. 

Two  styles  of  adjustable  seat  and  desk  were  found  in  these  schools 
varying  only  in  slight  and  unessential  details.  The  seats  and  desks  are 
adjustable  as  to  height  only.  The  seat  and  the  desk  behind  it  form  one  piece 
of  furniture  although  the  height  of  each  is  adjustable  separately.  In  some 
the  top  of  the  desk  turns  up  so  that  the  under  side  can  be  used  as  a  rack 
for  reading.  The  only  way  it  is  possible  to  adjust  the  distance  between 
seat  and  desk  is  by  moving  the  seat  and  the  desk  behind  it,  which  if  done 

23 


for  each  .child  would  spoil  the  alignment.  The  seat  and  desk  slide  up  and 
down,  being  held  in  position  by  a  nut  which  requires  a  wrench  to  tighten 
and  loosen. 

Another  type  of  adjustable  seat  is  used  in  a  few  of  the  schools  and 
here  the  seat  and  the  desk  are  separate  pieces  of  furniture  so  that  the 
knee  space  can  be  adjusted  for  each  child. 

All  seats  and  desks  are  fastened  to  the  floor.  The  Bureau  of  Fire  Pre- 
vention has  forbidden  the  use  of  unfastened  school  furniture.  The  old 
style  of  unadjustable  desks  and  seats  is  the  same  as  has  been  used  for  many 
years  and  with  which  everyone  is  familiar.  Some  of  the  desks  of  this  type 
are  built  so  that  the  top  may  be  used  as  a  reading  desk  if  desired. 

The  proportion  of  adjustable  and  non-adjustable  furniture  in  the  various 
schools  differed.  In  Nos.  9  and  166  they  were  almost  all  adjustable.  In 
No.  54  only  five  rooms  out  of  thirty-four  used  for  the  four  lower  grades 
were  provided  with  adjustable  seats  and  desks.  The  lack  of  adaptation  of 
the  desk  and  seat  to  the  child  also  varied  in  the  two  schools.  Both  were 
in  charge  of  unusually  intelligent,  capable  and  interested  principals.  In 
School  No.  9  where  the  principal  said  she  had  a  most  excellent  and  in- 
terested janitor  who  did  everything  he  was  asked,  the  conditions  found 
were  very  bad.  In  one  room  in  which  forty-four  girls  were  at  work, 
fourteen  were  found  to  be  sitting  at  desks  at  which  there  was  so  little 
knee  space  that  they  had  to  sit  sideways  with  their  knees  in  the  aisle.  As  a 
good  deal  of  attention  is  paid  to  requiring  the  children  to  sit  straight  in 
their  seats,  this  forced  the  child  to  twist  her  body  in  order  to  appear  to  be 
sitting  straight.  Two  seats  were  found  where  one  end  had  slipped  and  was 
at  least  two  inches  lower  than  the  other.  At  one  of  these  desks  was  found 
a  pale  girl,  over  tall  for  her  age,  seated  at  a  desk  with  at  least  six  inches 
too  little  knee  space  with  one  end  of  the  seat  lower  than  the  other,  and  in 
such  a  stage  of  chorea  that  she  was  unable  to  hold  her  body  still  a  moment. 

It  is  customary,  as  a  matter  of  routine,  to  adjust  the  seats  at  the  begin- 
ning of  the  year.  The  children  are  promoted  in  the  middle  of  the  year  and 
change  their  grades.  No  adjustment  of  seats  is  made  except  occasionally 
when  a  teacher  makes  a  special  request.  On  questioning  the  teachers  in 
several  of  these  classrooms  where  the  most  striking  examples  of  faulty 
position,  etc.  were  found,  they  admitted  readily  that  very  few  of  the  girls' 
desks  and  seats  were  suited  to  them,  but  that  they  were  seated  as  well  as 
the  teachers  could  arrange  it. 

At  school  No.  166  on  the  other  hand,  which  was  not  overcrowded, 
there  was  not  nearly  the  same  amount  of  bad  seating  noticed,  especially  as 
far  as  it  related  to  knee  room. 

In  all  the  schools  seen,  there  was  a  very  great  deal  of  bad  position  due 
to  improper  height  of  seat  and  desk.  It  was  impossible  for  a  large  propor- 
tion of  the  children — probably  a  majority — to  read  and  write  at  their  desks 
without  a  certain  amount  of  eye-strain. 

To  add  to  these  unfavorable  conditions,  the  seating  is  very  badly  ar- 
ranged in  many  class  rooms  in  relation  to  light.    In  many  cases  the  children 

24 


were  seen  doing  their  sums  or  writing  with  the  page  in  the  shadow  owing 
to  the  light  coming  from  the  right.  The  blackboards  were  very  trying  from 
certain  parts  of  the  room,  owing  to  the  glare  from  the  side  light  and  to 
make  matters  worse,  certain  of  the  teachers  were  using  red  and  green 
chalks  for  writing  figures  on  the  board. 

In  several  of  the  class  rooms  the  attempt  was  made  to  put  the  children 
with  known  defects  of  vision  in  the  front  row,  but  as  the  front  desks  were 
always  the  smallest  and  the  defects  were  often  in  the  largest  children,  the 
result  was  not  satisfactory. 

In  one  of  the  schools  the  only  light  was  gas,  which  on  a  dark  day, 
gave,  according  to  the  testimony  of  the  teachers  a  very  poor  illumination. 

From  their  own  investigation,  therefore,  this  Committee  finds  that 
the  present  method  of  seating  children,  the  desks  and  seats  provided  for 
them,  and  the  illumination  of  their  classrooms  all  are  tending  to  produce 
spinal  curvature  and  eyestrain  in  a  very  large  number  of  school  children. 

So  long  as  desks  and  seats  are  made  as  difficult  to  adjust  as  possible, 
so  long  as  the  adjusting  depends  upon  the  good-will  of  a  janitor,  so  long 
as  the  adjustment  can  only  be  made  for  height  without  regard  to  the  distance 
of  seat  from  desk,  the  children  will  be  subjected  to  conditions  sure  to  re- 
sult in  spinal  curvature  and  occular  defects. 

The  matter  is  of  sufficient  importance  to  demand  a  careful  and  thought- 
ful study. 


GONORRHEAL  VAGINITIS  IN  CHILDREN. 

The  wide  prevalence  of  the  disease  has  lead  the  Committee 
to  emphasize  the  need  of  certain  protective  measures  and  the  fol- 
lowing recommendations  were  made  which  were  submitted  to  the 
Department  of  Health  and  published  in  the  medical  press. 

1.  That  systematic  examinations  of  all  female  inmates  of 
institutions  or  homes  for  children  be  made  on  admission  and  re- 
peated from  time  to  time,  in  order  to  determine  the  prevalence  of 
the  disease,  the  method  of  introduction  and  spread,  and  the  possi- 
bility of  spontaneous  recovery  where  no  treatment  is  given. 

2.  That  those  in  charge  of  Day  Nurseries  should  be  informed 
of  the  great  danger  of  infection  and  taught  what  precautions  are 
necessary. 

3.  That  systematic  examination  of  babies  in  Day  Nurseries 
be  undertaken  by  the  Health  Department  to  determine  the  fre- 
quency of  infection  and  the  measures  necessary  to  diminish  it. 

25 


4-  That  the  only  way  of  protecting  the  city  hospitals  from 
the  blame  of  having  been  the  source  of  infection  is  to  make  the 
examination  of  smears  compulsory  in  the  case  of  every  female 
child  admitted. 

5.  That  patients  discharged  from  hospitals,  who  are  found  to 
be  infected,  be  followed  to  their  homes  and  an  effort  made  to  secure 
proper  treatment  for  them. 

6.  That  it  is  inadvisable  at  the  present  time  to  attempt  to 
determine  the  prevalence  of  the  disease  in  the  schools. 

WHOOPING  COUGH. 

The  Committee  made  an  inquiry  aimed  at  ascertaining  the 
facilities  for  isolating  children  suffering  from  Whooping  Cough 
and  finding  that  there  were  absolutely  none,  called  this  fact  to  the 
attention  of  the  Department  of  Health.  The  Committee  also  ad- 
dressed all  the  railroad  and  ferry  companies  having  terminals  in 
this  City  asking  that  discarded  ferryboats  be  loaned  to  the  De- 
partment of  Health  for  the  purpose  of  segregating  children  with 
whooping  cough  and  accommodating  them  during  the  day.  Sub- 
sequently, the  Department  secured  the  use  of  such  a  boat  from 
St.  John's  Guild. 

EMPLOYMENT  CERTIFICATES. 

The  Committee  investigated  in  19 12  the  methods  of  examina- 
tion of  children  applying  for  employment  certificates.  Several  con- 
ferences were  held  on  the  subject  and  various  suggestions  for 
stricter  physical  examinations  were  made. 

STANDARDS  FOR  PHYSICAL  EXAMINATION  OF  CHIL- 
DREN BETWEEN  THE  AGES  OF  14  AND  16  YEARS 
WORKING  IN  FACTORIES. 

In  response  to  a  request  from  the  New  York  Child  Labor 
Committee  and  the  Advisory  Council  of  the  State  Department  of 
Labor,  the  Committee  prepared  a  report  on  the  standards  of  physi- 
cal examination  of  children  between  the  ages  of  fourteen  and  six- 

26 


teen  years,  working  in  factories.  A  recent  amendment  to  the  Labor 
Law  empowers  the  Labor  Commission  to  cancel  the  working  papers 
of  children  found  working  in  factories,  who  are  sickly  and  whose 
health  is  likely  to  be  impaired  seriously  as  a  result  of  the  work  in 
factories.  The  report  on  the  standards  of  physical  examination  to 
be  adopted  for  such  children  was  submitted  by  the  Committee  to 
the  New  York  Child  Labor  Committee  and  to  the  Advisory  Council 
of  the  Department  of  Labor  in  January,  19 14.  The  report  is  as 
follows : 

Report  o'n  Standards  of  Physical  Examination  of   Children   Between 
Ages  of  14  and  16  Working  in  Factories. 

The  Department  of  Labor  was  authorized  by  the  Legislature,  in  1913, 
to  make  a  physical  examination  of  all  children  between  the  ages  of  14  and 
16  who  were  employed  in  factories  in  the  State.  Failure  on  the  part  of 
the  child  to  submit  to  this  examination  may  result  in  the  revocation  of  his 
or  her  working  papers  by  the  Commissioner  of  Labor.  If  the  results  of 
this  examination  convince  the  medical  inspector  that  the  child  is  unfit  for 
work  in  a  factory,  he  must  submit  a  detailed  report  to  the  Commissioner 
of  Labor,  stating  his  reasons  for  this  opinion,  and  the  Commissioner  may 
cancel  the  working  papers  of  the  child.  In  either  case  such  child  is  for- 
bidden to  work  in  any  factory  in  the  State  until  a  subsequent  physical 
examination  convinces  the  Inspector  that  he  is  fit  to  do  so,  when  the  work- 
ing papers  may  again  be  issued  to  the  child. 

A  complete  record  of  each  examination  is  to  be  forwarded  to  the  De- 
partment of  Labor  and  kept  on  file  there. 

According  to  the  Census  figures,  in  1910  there  were  8264  persons 
between  the  ages  of  14  and  16  employed  in  factories  in  the  State  of  New 
York,  of  whom  3955,  or  47.8  per  cent.,  were  males.  The  Industrial  Direc- 
tory issued  by  the  State  Department  of  Labor  gives  the  total  for  1912  as 
13.519,  of  whom  5173,  or  38  per  cent.,  were  males. 

It  is  understood  that  the  Department  is  planning  to  detail  two  Inspec- 
tors for  this  work.  If  all  these  children  were  examined  it  would  mean  27 
examinations  a  day,  on  the  basis  of  the  Census  figures,  or  45  a  day  on  the 
Industrial  Directory  figures.  If  only  boys  were  examined,  it  would  mean 
13  or  17  a  day.  It  is  not  known  whether  the  Department  intends  to  have  a 
woman  inspector  or  only  men. 

As  any  examination  which  is  of  any  value  must  involve  the  removal  of 
part  of  the  clothing,  it  would  seem  that  it  would  be  better  to  confine  the 
examination  during  the  first  year  to  the  boys.  If  the  results  of  these 
examinations  warranted  it,  they  could  be  made  the  basis  for  demanding  that 
the  girls  be  given  the  same  privilege.    In  such  case  a  woman  inspector  should 


27 


make   the   examination,   or  a   woman   be  present  at,   and  prepare  the  girl 
for  the  examination. 

The  examination  should  be  made  in  a  quiet  room,  with  a  good  light. 
The  child  should  be  stripped  to  the  waist.  Girls  should  be  covered  with  a 
cape  during  examination. 

Examination  should  include: 
Height. 
Weight. 

General  condition  of  nutrition. 

Evidences  of  deformity  of  the  limbs,  spine,  either  anatomical  or  postural. 
Evidences  of  marked  nervousness,  or  Chorea. 
Skin,  pallor,  cyanosis,  jaundice,  eruptions,  and  skin  disease. 
Eyes  and  eyesight. 
Condition  of  the  eyelids. 

Condition  of  the  Mouth,  Teeth,  and  Tonsils. 
Ears  and  Hearing. 

External  signs  of  obstructed  breathing,  probably  due  to  adenoids. 
Examination  of  the  Heart,  both  by  percussion  and  Auscultation. 
Examination  of  the  Lungs,  percussion.  Auscultation,  and  determination  of 

chest  expansion. 
Examination  for  Herniae. 

Cancellation  of  working  papers  should  be  recommended  under  any  of 
the  following  conditions : 
Weight — If  child  is  2  years  below  the  average   for  his   supposed  age,  or 

when  weight  is  markedly  below  normal  for  height. 
Condition  of  Nutrition — Evidence  of  marked  malnutrition. 
Deformity — If  due  to  his  employment,  and  likely  to  be  made  worse  by  it. 

This  alone  is  difficult  to  estimate  as  a  cause  for  cancellation,  as  certain 
employments  might  not  in  any  way  affect  the  child  adversely.  The  Depart- 
ment of  Labor  is  not  given  any  authority  to  regulate  the  character  of  em- 
ployment of  the  child. 

Nervousness — or  Chorea — If  marked  nervousness,  or  if  evidence  of  Chorea. 

Cervical  Glands — If  Tuberculous. 

Eyes — Serious  defects  of  vision  until  corrected. 

Eyelids — If  Trachoma. 

Mouth  and  Skin — If  evidence  of  Syphilis. 

Obstructed  Breathing — If  marked,  should  exclude  until  remedied. 

Heart — Any  signs  of  organic  Heart  Disease,  on  account  of  this  being  the 
time  when  a  lame  heart  is  most  likely  to  break  down.  The  character 
of  the  lesion,  and  the  nature  of  the  employment  would  have  an  influence 
in  the  decision. 

Lungs — Any  evidence  of  Tuberculosis. 

Hernia — Unless  controlled  by  a  truss,  and  in  every  case  of  irreducible  Hernia. 

28 


OPEN  AIR  CLASSES  IN  SCHOOLS. 

In  response  to  a  request  from  the  Board  of  Education  as  to  the 
relative  values  of  open  air  and  open  window  class  rooms,  in  Novem- 
ber, 1914  the  Committee  made  a  study  in  which  the  merits  of  the 
two  types  of  classes  were  carefully  examined.  A  comparison  of 
the  results  obtained  in  these  types  of  classes  in  the  public  schools 
shows  very  little,  if  any,  difference  in  favor  of  the  open  air  classes. 

In  view  of  this  and  inasmuch  as  the  money  available  for  effi- 
cient air  classes  is  limited  and  the  expense  of  construction  of  open 
air  classes  is  relatively  large,  the  Committee  recommended  that  the 
Board  of  Education  provide  a  large  number  of  open  window  rooms 
with  pivoted  windows  and  suitable  awnings  instead  of  the  more 
expensive  open  air  rooms. 

In  this  connection  the  Committee  also  recommended  that  the 
Board  of  Education  encourage  the  practice  among  teachers  of  open- 
ing the  windows  in  all  regular  schoolrooms.  The  attached  report 
sets  forth  in  greater  detail  the  basis  for  the  Committee's  conclusions. 

Definition — 

1.  Open  air  classes :  by  this  term  is  meant  classes  of  children  taught  in 
specially  constructed  rooms  or  houses  which  are  practically  open  air  pavilions. 

2.  Open  window  classes :  by  this  term  is  meant  classes  taught  in 
regular  rooms  of  school  buildings,  but  where  the  windows  have  been  altered 
to  open  on  pivots,  thus  securing  the  full  benefit  of  the  window  openings, 
and  where  these  windows  are  kept  open  all  the  time. 

Types  of  Children — 

It  is  understood  that,  for  the  most  part,  classrooms  of  both  the  above 
types  are  designed  for  children  who  are  anaemic  or  otherwise  below  par 
in  physical  condition. 

Desired  Condition  in  These  Classes — 

One  of  the  main  features  of  these  classes  is  a  relatively  low  tempera- 
ture, probably  best  ranging  from  40  degrees  to  50  degrees  F.  There  is 
no  evidence  to  show  that  any  increased  advantage  is  obtained  by  tempera- 
tures below  40  degrees  F.  Also,  it  is  desired  to  maintain  a  relative  humidity 
more  nearly  normal  than  is  usual  in  steam  heated  rooms,  and  in  addition, 
adequate  but  not  excessive  air  movement.  A  maximum  amount  of  sunlight 
in  the  winter  months  is  desirable,  and  protection  from  the  sun,  preferably 

29 


by  awnings,  in  the  spring  and  autumn.  Freedom  from  dust  and  noise  is 
important,  and  for  that  reason  the  rooms  should  be  at  least  three  floors 
from  the  ground.  In  winter  more  protection  from  wind  is  needed,  while 
in  the  spring  and  autumn  the  maximum  of  air  movement  that  can  be  ob- 
tained is  usually  desired. 

In  addition  to  these  physical  conditions  it  is  understood  that  there 
should  be  a  special  regime  in  these  classes  providing  especially  for  more 
relaxation  from  the  strain  of  regular  classes,  and  increased  periods  for 
rest.  In  addition  to  this,  adequate  clothing  for  the  comfort  of  the  children 
is  understood  to  be  necessary. 

Objection  to  Open  Air  Classes — 

1.  That  there  is  needless  and  possible  harmful  exposure  to  cold  in 
winter,  and  the  storms  in  all  seasons. 

2.  That  there  is  too  great  exposure  to  sun  and  heat  in  the  spring  and 
autumn. 

3.  That  the  cost  of  construction  and  equipment  is  considerable.  The 
cost  of  construction  of  one  of  these  rooms  frequently  amounts  to  several 
thousand  dollars.  The  cost  of  necessary  equipment  and  clothing  for  children, 
on  the  basis  of  that  found  necessary  in  the  best  private  open  air  rooms 
and  in  the  Chicago  public  schools,  is  $20  per  child,  as  opposed  to  about  $S 
per  child  in  open  window  rooms. 

Objection  to  Open  Window  Rooms — 

1.  Too  little  air  movement  in  spring  and  autumn. 

2.  Too  great  exposure  to  the  sun  in  the  spring  and  autumn,  because 
of  the  southern  exposure  of  such  rooms.  This  objection,  however,  could 
adequately  be  met  by  awnings. 

3.  Unequal  distribution  of  air  movements  in  the  room,  particularly 
in  the  winter,  exposing  the  children  near  the  windows  to  too  great  drafts 
and  colds. 

All  these  objections  appear  to  be  of  minor  importance. 

Comparative   Results  in   the   Physical   Condition   of   Chidren — 

Any  opinion  upon  the  relative  advantages  and  disadvantages  of  these 
two  types  of  rooms  must  ultimately  rest  upon  a  careful  review  of  the 
actual  results  obtained  with  the  children. 

Probably  the  best  results  have  been  obtained  in  open  air  classes  situated 
in  the  country  or  small  towns,  where  suitable  but  inexpensive  types  of 
construction  are  possible,  and  where  facilities  for  exercise  and  play  in  the 
open  immediately  adjoin  the  school  room.  The  forest  schools  of  Germany 
are  ideal  examples  of  this  class  of  school. 

Reports  based  on  a  careful  study  of  the  results  obtained  in  the  im- 
proved physical  condition  and   increased   mental  efficiency  of   the  children 


30 


in  large  cities  shows  a  slight  balance  in  favor  of  the  open  air  classes. 
These  reports,  however,  do  not  indicate  sufficient  difference  to  demonstrate 
any  marked  superiority  of  open  air  classes  over  the  open  window  classes. 

Conclusion — 

In  the  public  schools  of  large  cities  the  provision  of  open  air  classes 
presents  considerable  difficulties  and  objections,  especially  in  a  climate  with 
such  variations  of  temperature  as  obtain  in  New  York  City.  A  com- 
parison of  the  results  obtained  in  these  two  types  of  classes  in  the  public 
schools  shows  very  little,  if  any,  difference  in  favor  of  the  open  air  classes. 

Consequently,  inasmuch  as  the  money  available  for  fresh  air  classes 
is  limited  and  the  expense  of  construction  of  open  air  classes  very  con- 
siderable, we  recommend  that  the  Board  of  Education  provide  a  larger 
number  of  open  window  rooms  with  pivoted  windows  and  suitable  awnings, 
rather  than  the  so-called  open  air  rooms. 

We  would  also  recommend  that  the  Board  of  Education  encourage 
the  practice  among  teachers  of  opening  the  windows  in  all  regular  school 
rooms. 


MENTAL  FATIGUE  IN  SCHOOL  CHILDREN. 

In  view  of  the  differences  of  opinion  among  educators  as  to 
the  question  of  half  time  schooling  of  young  children,  the  Bureau 
of  Municipal  Research  submitted  the  matter  to  this  Committee 
for  an  opinion.  Careful  consideration  of  the  problem  led  the  Com- 
mittee to  express  an  opinion  that  an  ordinary  full  school  day  is  not 
detrimental  to  the  brain  power  and  health  of  the  children  provided 
the  physical  conditions  of  the  school  rooms  are  satisfactory  and 
arrangement  of  the  school  tasks  is  wisely  planned. 

The  following  is  the  brief  report  of  the  Committee  on  the 
subject. 

A  careful  study  has  been  made  of  the  special  questions :  First,  whether 
the  mental  activity  involved  in  the  five  hours  daily  of  modern  school  life 
causes  mental  fatigue  and  if  so  whether  such  fatigue  is  serious,  passing 
beyond  safe  physiological  limits.  Second,  whether  such  mental  fatigue  if 
found  is  due  to  excessive  mental  work,  or  to  other  causes  in  part  or  whole. 

The  Committee  has  reached  the  conclusion  that  there  is  no  serious 
degree  of  mental  fatigue  produced  by  school  work  in  the  usual  five  hour 
limit,  and  that  it  is  unnecessary  to  shorten  school  hours  on  account  of  this 
school  work.  A  certain  degree  of  mental  fatigue  is  found  towards  the  end 
of  the  morning  and  of  the  day's  tasks,  but  it  is  small  in  amount  and  unim- 

31 


portant.  This  fatigue  such  as  it  is,  is  enhanced  and  mainly  caused  by 
poor  ventilation  and  ill-arranged  tasks.  More  than  normal  fatigue  may 
also  occur  in  children  who  are  poorly  nourished,  not  entirely  well,  or  are 
under  unfavorable  home  conditions. 

It  is  believed,  therefore,  that  if  all  these  factors  be  attended  to  no 
shortening  of  school  hours  need  be  attempted. 

It  is  also  believed  that  some  summer  work  can  be  carried  on  with- 
out  danger  and  even  to  the  great  advantage   of  the  child. 

These  views  are  based  upon  the  personal  experiences  of  some  of  the 
members  of  the  Committee,  but  more  especially  upon  the  results  of  con- 
ferences with  physiologists,  physicians  and  teachers  who  have  made  a 
special  study  of  this  subject. 

We  refer  especially  to  the  works  of  Professor  Frederic  S.  Lee  on 
Fatigue,  and  on  Ventilation ;  to  those  of  Prof.  Edward  Thorndike  on  Mental 
Fatigue,  Psychological  Review,  November  1900;  and  to  recent  personal  com- 
munications from  him.  We  have  also  consulted  the  work  of  Whipple  on 
Mental  Tests ;  the  article  of  Dr.  R.  G.  Freeman  on  Fatigue  in  School 
Children,  American  Journal  of  Medical  Sciences,  November  1908;  the  study 
of  Mental  Fatigue  by  Prof.  W.  H.  Heck  of  Lynchburg,  Va.,  1913,  and  a 
Second  Study  by  Prof.  Heck,  the  Psychological  Clinic,  April  15,  1913. 

The  Committee  has  also  conferred  with  Prof.  George  V.  N.  Dearborn 
of  Tufts  Medical  College  and  a  number  of  other  physicians  and  teachers. 

It  is  not  denied  that  children  do  get  tired  at  the  end  of  school  hours, 
that  in  the  spring  and  towards  the  end  of  a  school  term,  chorea  is  seen 
more   frequently  and  that   evidence  of   overwork  and   fatigue   is   observed. 

The  position  taken  is  that  these  conditions  are  not  necessary  to  a  five 
hour  school  day,  but  are  due  to  unwise  methods  of  teaching,  poorly  ar- 
ranged schedules,  bad  air,  and  various  causes  other  than  legitimate  school 
work. 

It  is  again  strongly  urged  that  shorter  vacations  or  an  almost  continu- 
ous yearly  school  work,  if  the  work  is  wisely  planned,  would  be  advantag-- 
ecus  to  many  children  as  has  been  already  demonstrated  in  certain  public 
schools  of  this  country. 

The  above  observations  apply  to  the  ordinary  school  work  done  between 
the  ages  of  six  and  fourteen. 

CARE  OF  CARDIAC  CASES. 

(a)  The  problem  of  proper  medical  and  educational  care  of 
children  suffering  from  chronic  valvular  disease  of  the  heart  has 
been  discussed  by  the  Committee  and  a  preliminary  study  made 
which  showed  that  inadequate  provision  exists  for  their  care  in 
the  hospitals  of  this  City  and  similarly,  inadequate  attention  is 
being  paid  to  children  suffering  from  heart  disease  who  attend  the 

32 


public  schools.    The  report  was  submitted  to  the  recently  organized 
society  for  the  care  and  provision  of  heart  disease  in  children. 

(b)  The  matter  of  a  study  of  occupations  best  suited  to  the 
cardiac  patients  was  suggested  by  the  Committee  to  the  School  of 
Philanthropy.  Such  a  study  was  made  on  the  basis  of  records  of 
discharged  patients  from  Bellevue  Hospital. 

OVERCROWDING  IN  INSTITUTIONS  FOR  INFANTS. 

The  attention  of  the  Committee  has  been  called  to  the  existing 
overcrowding  in  institutions  for  the  care  of  infants.  It  was  stated 
that  one  of  the  reasons  for  this  condition  is  the  inadequacy  of  the 
present  law  regulating  the  cubic  space  allottment  per  child.  The 
law  is  not  based  on  any  scientific  premises. 

The  matter  was  referred  for  study  to  the  Section  on  Pediatrics 
of  the  New  York  Academy  of  Medicine  and  is  being  considered  by 
a  special  committee  of  the  Section. 

GARY  SYSTEM. 

The  Committee  has  taken  an  interest  in  the  health  possibilities 
which  the  so-called  Gary  System  of  school  instruction  affords,  and 
held  two  conferences  with  Mr.  William  Wirt,  originator  of  the 
plan.  As  there  have  been  no  studies  made  of  the  effect  of  the 
system  upon  the  health  of  the  school  children,  the  Committee  sug- 
gested to  the  Department  of  Health  the  desirability  of  making  a 
study  of  the  hygienic  aspects  of  the  system  and  offered  its  co- 
operation in  such  a  study. 


33 


IV 


VITAL  STATISTICS 


VITAL  STATISTICS  IN  THE  CITY  OF  NEW  YORK. 

The  Committee  made  a  study  of  the  reports  of  the  Department 
of  Health,  particularly  the  reports  on  vital  statistics.  The  study 
revealed  the  fact  that  there  was  a  large  field  for  improvement  in  the 
scope  of  the  reports  and  the  methods  of  procedure.  The  study  was 
pubHshed  in  the  Medical  Record  of  November  23,  1912,  and  the 
following  were  the  chief  recommendations : 

1.  That  the  Department  of  Health  re-organize  and  enlarge  the  Bureau 
of  Records  in  accordance  with  the  recommendations  of  the  Advisory  Com- 
mittee of  Statisticians  made  in  191 1,  and  subdivide  the  Bureau  into  three 
divisions :    of  Records,  properly,  of  Research  and  of  Publicity. 

2.  That  the  Board  of  Estimate  and  Apportionment  appropriate  the 
money  necessary  for  the  enlargement  of  the  Bureau  of  Records  in  the  in- 
terests of  efficient  administration  and  the  public  health  movement  and  that 
the  salaries  fixed  for  the  responsible  officers  of  the  Bureau  be  such  as  to 
enable  the  Department  to  secure  vi^ell  trained  men  for  the  positions. 

3.  That  the  work  of  the  re-organized  Bureau  be  undertaken  on  a  com- 
prehensive scale  and  in  accordance  with  modern  scientific  methods. 

4.  That  all  the  statistical  work  of  the  Department  be  done  under  the 
direction  of  the  Bureau  of  Records  to  secure  accuracy  and  uniformity  of 
method,  and  that  the  records  be  promptly  available. 

5.  That  the  reports  of  the  Bureau  of  Records  be  published  independ- 
ently of  the  annual  report  of  the  Department  of  Health  and  be  ready  for 
distribution  early  every  year. 

6.  That  the  city  undertake  a  local  population  census  every  ten  years, 
beginning  in  1915,  and  that  the  40  acre  tract  unit  of  the  last  federal  census 
be  made  the  basis  for  tabulation. 

7.  That  the  medical  colleges  instruct  their  students  in  the  methods  and 
principles  of  medical  and  vital  statistics. 

8.  That  the  medical  press  give  more  analysis  to  public  health  reports 

34 


and  vital  statistics  and  impress  the  profession  with  the  importance  of  exact 
vital  statistics,  urging  them  to  co-operate  vi^ith  the  Bureau  of  Records  in 
making  prompt,  careful  reports. 

9.  That  the  Department  of  Health  make  greater  efforts  to  issue  prompt- 
ly its  annual,  monthly  and  weekly  reports. 

ID.  That  the  weekly  report  be  changed  from  a  purely  statistical  sheet 
to  an  educational  pamphlet  intended  primarily  for  the  general  public,  and 
that  arrangements  be  made  with  the  newspapers  of  the  city  for  periodic 
reproduction  of  the  essential  parts  of  the  report. 

II.  That  more  and  better  means  of  contact  between  the  Department 
of  Health  and  the  public  be  established  in  the  interest  of  efficient  adminis- 
tration and  of  the  public  health  movement,  and  that  the  public  regularly 
receive  information  regarding  the  Department's  most  vital  functions — food 
and  milk  inspection,  prevention  of  disease  and  care  of  babies  and  school 
children. 


MORBIDITY  STATISTICS. 

The  need  of  morbidity  statistics  outside  of  contagious  diseases 
has  been  recognized  by  the  Committee  and  the  plan  of  Dr.  Charles 
F.  Bolduan  of  the  New  York  City  Department  of  Health,  pub- 
lished as  a  special  bulletin  of  the  Department  has  been  carefully 
studied  by  the  Committee  and  endorsed.  Some  method  of  hospital 
registration  of  morbidity  seems  to  be  necessary  and  highly  desir- 
able, as  studies  made  in  various  places  by  Dr.  Frederick  L.  Hoff- 
mann and  others  have  demonstrated. 

NEW  YORK  STATE  CENSUS,  1915. 

In  response  to  a  request  from  a  conference  called  to  consider 
the  matter  of  the  State  Census  to  be  taken  in  the  year  191 5,  the 
Committee  took  up  the  matter  carefully  and  recommended  that 
the  Legislature  appropriate  sufficient  funds  to  enable  the  State  au- 
thorities to  undertake  a  census,  which  would  add  materially  to  our 
knowledge  of  social,  economic  and  public  health  conditions  of  the 
State,  and  that  the  work  of  taking  the  Census  be  entrusted  to  the 
police  departments  in  large  cities  and  be  carried  out  throughout  the 
State  with  the  co-operation  of  the  State  Department  of  Labor  and 
the  State  Department  of  Health  which  is  charged  with  the  duty  of 
collecting  and  publishing  the  vital  statistics  of  the  State. 


35 


REPORT  ON  THE  NEW  YORK  STATE  CENSUS.   1915 

I.  Historical  : 

The  constitution  of  the  State  of  New  York,  as  adopted  November  3, 
1846,  provides  that  a  census  be  taken  everj'  ten  years,  for  the  purpose  of 
ascertaining  the  increase  and  distribution  of  the  population,  to  serve  as  a 
basis  for  assembly  and  senate  districts.  Usually,  in  addition  to  the  essential 
facts  called  for  in  a  census — namel}-,  the  number  of  inhabitants  by  counties 
and  their  subdivisions,  by  sex  and  citizenship,  censuses  contain  additional 
information  of  social  value.  Thus,  the  New  York  State  censuses  for  1855, 
1865  and  1875  contained  additional  information  as  to  sex,  marriages,  deaths, 
dwellings,  agriculture,  manufactures,  public  debt,  churches,  school  houses, 
the  blind,  deaf  and  dumb,  occupations,  and  other  information.  In  1885  no 
census  was  taken.  It  was  ordered,  however,  in  1892.  The  next  census 
was  taken  in  1905  and  it  was  a  mere  enumeration  of  the  population  by 
counties,  cities,  towns  and  election  districts  of  citizens  and  aliens  and  also 
an  enumeration  of  Indians,  and  a  count  of  inmates  in  institutions. 

II.  Facts  to  be  Ascertaixed  by  the  Census  : 

A  State  census  is  important  for  many  other  than  political  reasons. 
When  taken  five  years  after  the  Federal  Census  it  gives  an  accurate  count 
of  the  population  at  a  time  when  estimates  become  unreliable.  In  a  dynamic 
community  with  considerable  internal  and  foreign  migrations,  neither  the 
arithmetical  nor  the  geometrical  method  of  estimating  the  population  for  a 
period  of  ten  years,  is  satisfactory.  The  death  rates,  morbidity  rates  and 
marriage  rates,  based  on  untrustworthy  estimates  of  population,  are  not 
only  valueless  but  misleading. 

To  enhance  the  value  of  a  State  census  such  facts  as  have  a  bearing  on 
the  social  and  economic  status  of  the  population,  and  may  be  helpful  in 
determining  social  politics,  should  be  ascertained. 

The  fundamental  questions  in  such  a  census  should,  in  addition  to  county 
distribution  and  citizenship  of  the  population,  deal  with  such  factors  as : 
I.    Sex. 


Color. 

Age. 

Nativity. 

Marital  condition. 

Occupation. 

Fecundity  of  marriage  with  reference  to  the  nativity  of  both  parents. 

Sickness  in  the  family  during  the  year  previous  to  the  taking  of  the 

census. 

Unemployment  during  the  year  preceding  the  census,  due 

(a)  to  sickness. 

(b)  to  other  condition. 

The  census  should  also  ascertain  the  number  of  persons  living  in  insti- 
tutions throughout  the  State. 

36 


III.  By  Whom  Should  the  Census  be  Taken  : 

The  State  Law  provides  that  the  census  should  be  taken  under  the 
direction  of  the  Secretary  of  State.  The  experience  of  the  Federal  and 
State  authorities  demonstrates  the  inadvisability  and  costliness  of  employing 
casual  census  enumerators.  Many  of  the  enumerators  have  proven  to  be 
incapable  and  dishonest  in  carrying  out  their  duties.  Moreover,  the  control 
of  their  work  is  very  difficult  and  costly.  It  would  be  much  more  satisfactory 
if  the  police  forces  of  the  large  cities  of  the  State  could  undertake  the  task 
of  census  taking  in  their  respective  cities.  In  the  smaller  towns  or  in  rural 
sections,  the  task  should  be  entrusted  to  letter-carriers  if  the  consent  of  the 
Federal  Government  could  be  obtained.  The  work  should  be  carried  out 
under  the  direction  of  a  Board  appointed  by  the  Secretary  of  State  and 
should  include  representatives  of  the  State  Department  of  Health  and  the 
State  Department  of  Labor.  The  co-operation  of  the  State  Department  of 
Health  is  especially  desirable  as  this  Department  is  charged  with  the  duty 
of  keeping  the  Vital  Statistics  of  the  State.  Moreover,  the  direct  contact 
with  the  people  all  over  the  State,  which  the  taking  of  the  Census  would 
afford,  would  give  the  Department  of  Health  direct  knowledge  of  conditions 
responsible  for  the  public  health  in  the  State. 

IV.  Recommendations: 

In  view  of  the  facts  presented,  it  would  be  helpful  and  advantageous 
if  the  Academy  of  Medicine  would  urge  upon  the  State  Legislature  that  suf- 
ficient funds  be  appropriated  to  enable  the  State  authorities  to  undertake 
a  census  which  should  add  to  our  knowledge  of  the  social,  economic  and 
public  health  conditions  of  the  State.  (2)  That  the  Census  contain  questions 
bearing  on  the  age,  sex,  color  and  nativity  distribution  of  the  population,  as 
well  as  on  the  marital  state,  fecundity,  morbidity  and  extent  of  non-employ- 
ment within  the  State.  (3)  That  the  work  of  taking  the  Census  be  entrusted 
to  the  police  departments  in  large  cities,  and  be  carried  out  with  the  co- 
operation of  the  State  Department  of  Health  and  the  State  Department  of 
Labor. 


37 


V 


IMPROVLMLNT  OF  LIVING  AND  WORKING 
CONDITIONS 


OCCUPATIONAL  DISEASES. 

Recognizing  the  importance  of  prevention  of  the  so-called  Oc- 
cupational Diseases,  the  Committee  has  co-operated  with  the  Spe- 
cial Committee  of  the  American  Association  of  Labor  Legislation 
in  drafting  Legislation  aimed  at  the  registration  and  prevention  of 
Industrial  Diseases.  To  stimulate  the  general  interest  in  the  mat- 
ter among  the  profession  and  the  public  at  large  the  Committee 
arranged  a  meeting  at  the  Academy  of  Medicine,  which  was  held 
on  January  4,  1912,  and  which  was  devoted  to  the  consideration 
of  the  problem. 

At  that  meeting  Dr.  W.  Oilman  Thompson  spoke  on  the  im- 
portance and  prevalence  of  Occupational  Diseases ;  Dr.  Leonard  W. 
Hatch,  Statistician  of  the  New  York  State  Department  of  Labor 
read  a  paper  on  the  "State  Control  of  Occupational  Diseases;" 
Dr.  George  T.  Elliot  discussed  "Occupational  Skin  Diseases ;"  Dr. 
M.  Allen  Starr,  "Occupational  Neuroses." 

The  Committee  endorsed  the  establishment  of  the  Division  of 
Industrial  Hygiene  in  the  Bureau  of  Preventable  Diseases  of  the 
Department  of  Health  and  followed  with  interest  the  development 
of  the  work  of  the  Division.  It  has  also  kept  in  touch  with  the 
useful  activities  along  similar  lines  that  have  been  carried  on  by 
the  American  Museum  of  Safety  and  their  plans  of  extension. 


CHRONIC  CARDIO-VASCULAR  DISEASES. 

The  apparent  increase  in  the  rate  of  mortality  of  persons  in 
the  age  group  from  45  to  55  has  been  investigated  by  the  Com- 
mittee and  a  recommendation  made  to  the  Commissioner  of  Health 
to  the  effect  that  an  active  campaign  'on  the  part  of  the  Depart- 
ment of  Health  be  undertaken  toward  the  instruction  of  the  public 
in  matters  of  personal  hygiene  by  means  of  tracts,  pamphlets,  lec- 
tures and  the  like,  as  it  was  the  belief  of  the  Committee  that  such 
a  campaign  would  have  a  definite  influence  in  securing  a  diminution 
in  morbidity  and  mortality  from  cardio-renal  and  the  vascular  dis- 
eases at  the  age  periods  of  greatest  economic  efSciency. 

PERIODIC  PHYSICAL  EXAMINATION   OF  CITY 
EMPLOYEES. 

The  attention  of  the  Committee  to  this  matter  was  first  called 
by  the  statement  that  a  great  deal  of  tuberculosis  is  prevalent 
among  school  teachers,  and  led  the  Committee  to  make  inquiries  of 
the  Board  of  Education  as  to  whether  or  not  provision  is  being 
made  for  the  periodic  physical  examination  of  school  teachers.  It 
was  the  Committee's  belief  that  such  examinations  are  particularly 
indicated  in  the  case  of  teachers  who  come  into  contact  with 
children  at  the  ages  in  which  they  are  most  susceptible  to  the  con- 
tracting of  disease.  The  inquiry  revealed  the  fact  that  no  provision 
has  been  made  for  such  systematic  examinations.  The  Committee 
urged  that  examinations  of  a  standard  form  be  introduced  in  the 
schools  and  has  recommended  to  the  Committee  on  the  Prevention 
of  Tuberculosis  of  the  Charity  Organization  Society  that  the  matter 
receive  careful  attention  on  their  part  and  that  some  form  of  co- 
operation with  the  Department  of  Education  be  established. 

The  Committee  believes  that  the  principle  of  periodic  physical 
examination  should  be  extended  to  all  City  employees,  and  the 
suggestion  made  to  the  Health  Department  that  this  be  first  intro- 
duced in  the  Department  charged  with  the  control  of  the  City's 
health  has  been  favorably  acted  upon  and  such  examinations  are 
now  being  regularly  made.  Since  that  time  two  other  City  De- 
partments have  followed  suit. 


39 


In  co-operation  with  the  Health  Department  and  other  medical 
agencies  on  which  this  Committee  was  represented,  a  uniform  ex- 
amination card  was  devised.  The  card  and  the  introductory  notes 
in  connection  with  it  are  given  herewith. 

Explanatory  Notes  to  Accompany  Medical  Examination  Card 

The  Doctor  is  asked  to  read  the  explanatory  notes  which  go 
with  the  Medical  Examination  Card  in  order  that  some  uniformity 
of  answers  may  prevail. 

The  sub-headings  listed  below  suggest  the  minimum  amount 
of  information  that  should  be  given  regarding  each  individual  ex- 
amined. Anything  of  significance  not  included  in  the  sub-head- 
ings, should,  of  course,  be  stated. 

These  notes  have  been  contracted  as  much  as  possible  so  that 
a  Doctor  may  be  able  to  perform  an  examination  in  from  20  to  30 
minutes. 

Use  the  plus  sign  (  +  )  up  to  four  plusses  to  indicate  much  or 
little,  as :    "Tonsils  hypertrophied  +  +." 

Where  there  is  nothing  of  importance  to  be  recorded  use  the 
word  "negative." 


40 


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41 


HOUSING  PROBLEMS. 

The  matter  of  housing  conditions  of  the  congested  sections  of 
the  City  received  a  great  deal  of  attention  on  the  part  of  the  Com- 
mittee. Numerous  conferences  were  held  on  the  subject  and  the 
advantages  and  disadvantages  of  the  so-called  "Open  Stair  Tene- 
ments" built  by  the  Tenement  Economies  Society  were  carefully 
investigated  and  various  legislative  proposals  discussed. 

The  proposal  of  the  Tenement  Economies  Society  to  create  a 
Board  of  Appeals  from  the  decisions  of  the  Tenement  House  De- 
partment was  deemed  inadvisable  and  contrary  to  the  proposal  of 
fixing  responsibility  in  the  administrative  branches  of  the  Govern- 
ment. The  Committee  was  not  certain  whether  the  other  proposal 
of  the  Tenement  Economies  Society,  aiming  at  the  reduction  of 
the  legal  minimum  width  of  tenement  house  rooms  from  7  to  6 
feet  was  a  rational  measure. 

The  whole  problem  of  housing  is  so  interrelated  with  various 
economic  and  social  problems  that  the  purely  public  health  aspect 
of  it  cannot  be  separated  from  the  other  considerations.  For  that 
reason  the  Committee  did  not  feel  justified  in  endorsing  the  Marsh 
Bills,  which  were  introduced  at  the  last  session  of  the  Legislature, 
and  which  aimed  at  the  abolition  of  certain  types  of  cellar  dwellings. 

The  Committee,  protested  however,  against  the  recent  attempt 
to  amend  by  ordinance  of  the  Board  of  Aldermen  the  recently  en- 
acted Building  Code  of  the  City  so  as  to  permit  the  reduction  of  the 
required  four  feet  width  of  side  yards  to  three  feet. 

STREET  CLEANING. 

The  neglect  of  the  streets  and  pavements  of  the  City  on  ac- 
count of  imperfect  and  antiquated  methods  of  cleaning  and  build- 
ing, and  also  because  of  the  numerous  building  and  excavating 
operations  led  the  Committee  to  present  a  statement  of  the  condi- 
tions observed  to  the  City  Department  on  Street  Cleaning,  with  the 
request  that  steps  be  taken  to  improve  the  existing  conditions  in  the 
interests  of  health,  welfare,  and  decency.  The  report  of  the  Com- 
mittee led  to  a  series  of  conferences  on  the  subject  with  the  repre- 

42 


sentatives  of  the  City  Government,  such  as  the  Street  Cleaning 
Department,  the  Police  Department,  the  Health  Department,  the 
Department  of  Water  Supply,  and  the  presidents  of  the  various 
boroughs  of  the  City  who  have  jurisdiction  over  the  paving  of  the 
streets. 

At  these  conferences  the  various  matters  entering  into  the 
situation  were  thoroughly  discussed  and  a  policy  of  procedure 
agreed  upon.  The  Committee  strongly  urged  the  appropriation  of 
money  for  the  model  districts  in  order  to  test  out  the  efficiency  of 
the  various  mechanical  street  cleaning  contrivances  in  the  market. 

The  Committee  also  urged  the  covering  of  garbage  and  ash 
carts  during  the  collection  of  refuse  and  during  the  process  of 
carting  it  through  the  streets  of  the  City. 

It  was  also  urged  that  the  Police  Department  co-operate  in 
enforcing  City  ordinances  concerning  the  covering  of  ash  and  gar- 
bage cans  and  the  cleaning  of  sidewalks. 

The  Health  Department  was  urged  not  to  issue  permits  to 
private  ash-cart  men  who  would  employ  in  their  work  uncovered 
carts.  The  Committee  feels  that  its  efforts  in  this  direction  have 
been  partially  successful  as  the  conditions  of  the  streets  have  some- 
what improved.  No  important  improvements,  however,  can  be 
made  until  the  public  takes  more  interest  in  the  appearance  of  the 
streets  and  refrains  from  littering  them  with  paper,  fruit  peels, 
and  other  kinds  of  refuse. 

The  Committee  has  endorsed  the  organization  of  the  Anti- 
Litter  League  whose  aim  it  is  to  educate  the  people  in  taking  pride 
in  the  clean  appearance  of  the  City  streets. 

The  Committee  has  published  in  the  Nezv  York  Medical  Record 
of  December  i8,  1915,  a  report  on  the  pathogenicity  of  street  dust, 
which  is  a  summary  of  the  existing  literature  on  the  subject.  A 
concensus  of  scientific  opinion  on  the  matter  based  on  tests  shows 
that  the  City  dust  contains  very  large  quantities  of  pathogenic  bac- 
teria which  may  be  responsible  for  a  large  amount  of  illness  of  the 
respiratory  tract. 


43 


Report  on  Street  Cleaning  by  the  Public  Health,  Hospital 
AND  Budget  Committee. 

The  Committee  find  that  the  streets  of  Greater  New  York, 
with  few  exceptions,  are,  and  have  been  much  neglected.  This  is 
due  not  only  to  imperfect  and  antiquated  methods  of  cleaning 
streets,  but  to  the  imperfect  state  of  the  pavements,  to  the  numerous 
building  and  excavating  operations,  and  to  the  general  indifference 
of  the  public  who  seem  to  regard  the  street  as  the  proper  place 
for  the  dumping  of  litter  and  refuse.  H  the  conditions  are  to  be 
improved,  the  Committee  feels  that  it  is  necessary  to  secure  the 
active  co-operation  of  the  Street  Cleaning  Department,  of  the  Police 
Department  for  the  enforcement  of  ordinances,  of  the  Department 
of  Health,  of  the  Department  of  Water  Supply,  Gas  and  Electricity, 
which  controls  the  issuing  of  permits  for  the  opening  of  streets 
and  of  the  Presidents  of  the  various  Boroughs  who  have  jurisdic- 
tion over  the  paving  of  the  streets,  and  also  to  arouse  public  senti- 
ment to  a  conviction  that  clean  streets  are  essential  to  health  and 
welfare. 

Street  Cleaning  Methods 

We  protest  against  the  present  antiquated,  expensive  and 
Tunsatis factory  methods  of  street  cleaning  as  practised  in  this  City. 
Dirt  and  refuse  are  often  collected  only  to  be  scattered  again. 
Dustless  sweeping  should  be  enforced.  We  urge  liberal  flushing 
with  water  and  a  more  general  use  of  machine  sweepers.  The 
Board  of  Estimate  and  Apportionment  should  be  induced  to  pro- 
vide proper  facilities  and  sufficient  equipment  including  horse- 
drawn  or  motor  sweepers  and  squeegees,  such  as  are  in  use  in 
London,  Berlin,  Paris,  Washington,  St.  Louis  and  many  other  cities. 

We  maintain  that  the  streets  should  be  sprinkled  before  sweep- 
ing, if  the  thermometer  register  38  degrees  F.  or  above,  the  tem- 
perature approved  by  the  experience  of  other  cities,  and  also  that 
the  sweeping  be  done  vigorously. 

We  urge  the  amendment  of  Section  39  of  the  Sanitary  Code 
of  the  Department  of  Health  so  as  to  permit  of  flushing  the  streets 
before  sweeping.  H  necessary,  sewers  should  be  screened  to  avoid 
blocking. 

44 


Instruction  of  Sweepers 

Manual  sweeping  is  essential,  but  as  done  at  present  is  ex- 
tremely unsatisfactory.  The  street-cleaning  force  should  be  im- 
proved and  increased,  and  definite  sweeping  methods  established 
and  taught. 

The  Collection  of  Sweepings 

We  protest  against  leaving  the  gathered  sweepings  in  heaps  in 
the  streets,  and  against  the  prevailing  neglect  in  gathering  up  gross 
refuse  matter,  and  we  urge  that  covered  receptacles  be  supplied 
for  sweepings  and  that  these  be  kept  covered  while  awaiting  the 
arrival  of  carts. 

Covered  Ash  and  Garbage  Cans 

The .  open  ash  and  the  carelessly  covered  garbage  cans  and 
barrels  are  a  disgrace  to  the  city  and  a  menace  to  public  health. 
In  the  warm  months  open  garbage  cans  attract  and  support  the 
housefly  in  great  numbers  and  facilitate  the  dissemination  of  dis- 
ease. The  Police  and  Health  Departments  should  enforce  existing 
ordinances  regarding  the  use  of  covered  garbage  cans. 

Covered  Carts 

The  uncovered  cart  for  the  removal  of  ashes,  garbage  and 
rubbish  is  a  public  nuisance.  We  urge  that  this  matter,  which  has 
been  referred  to  in  reports  of  the  Street-Cleaning  Department  and 
considered  by  the  present  Commissioner,  be  settled  by  the  adoption 
of  a  suitable  and  practical  covered  cart. 

The  private  ash-cart  men  are  the  worst  offenders  and  yet  they 
carry  prominently  on  the  sides  of  the  wagon  a  permit  from  the 
Board  of  Health.  We  suggest  that  the  Board  of  Health  refuse  a 
permit  unless  the  cart  be  covered,  and  the  private  cart-men  con- 
tract to  collect  and  remove  ashes  and  garbage,  only  during  the 
night  or  early  morning  hours. 

We  recommend  the  compulsory  use  of  some  standard  ash  can 
and  the  introduction  of  well-known  modern  methods  for  the  final 
disposal  of  ashes  and  garbage.  The  City  should  erect  a  sufficient 
number  of  modern  incinerators. 


45 


Snow  Removal 

The  slow  removal  of  snow  has  been  in  the  past  extremely  un- 
satisfactory and  insanitary.  We  urge  that  the  Street-Cleaning  De- 
partment make  such  provision  that  with  every  fall  of  snow  its 
removal  may  be  begun  immediately. 

Street  Encumbrances 

We  protest  against  the  unlawful  blocking  of  streets  by  build- 
ing material  and  the  frequent  and  uncontrolled  destruction  and  ob- 
struction of  the  highways  by  the  public  service  corporations. 

Co-operation  of  City  Departments 

We  urge  that  the  other  city  departments  co-operate  with  the 
Street  Cleaning  Department  in  a  general  movement  for  out-door 
cleanliness.  Filth,  dust,  and  dirt  on  the  streets,  especially  near  the 
markets  and  in  the  crowded  quarters  of  the  City  where  food-stufifs 
are  long  exposed  on  the  streets,  call  for  the  intervention  of  the 
Health  Department. 

The  Presidents  of  the  several  Boroughs  should  be  urged  to 
co-operate  by  continuing  and  increasing  their  efforts  to  provide 
better  pavements  and  prompt  repair  of  any  defects. 

Control  of  Streets 

We  urge  a  concentration  of  authority  over  the  highways  under 
one  head.  This  change  should  be  incorporated  in  a  revision  of 
the  Charter — Sanitary  cleanlifiess  and  efificiency  involve  the  single 
control  of  pavements,  streets  excavations  and  encumbrances,  the 
cleaning  of  streets  as  well  as  the  gathering  and  disposal  of  refuse. 


TEACHER  MOTHERS. 

At  the  request  of  the  Department  of  Education  the  Committee 
prepared  a  report  on  the  Teacher-Mother  problem  in  relation  to 
health,  of  which  the  following  is  a  summary: 

I.     No  woman  should  be  permitted  to  teach  after  the  sixth  month 
of  her  pregnancy. 

46 


2.  The  ability  of  a  woman  to  teach  during  this  time  is  an  indi- 
vidual question,  each  case  to  be  determined  by  its  own  merits. 

3.  The  average  time  of  the  return  to  school  after  confinement  is 
not  to  be  less  than  three  months. 

4.  While  a  healthy  child  may  interfere  very  little  with  a  teacher's 
work,  the  care  of  a  delicate  child  at  home  may  totally  unfit 
her  for  her  duties  at  school. 

The  attached  report  was  submitted  to  the  Board  of  Education 
and  also  to  the  Commissioner  of  Education  of  the  State  of  New 
York  for  information  and  guidance. 

The  question  of  teacher-mothers  is  an  important  one  and  the  decision 
of  New  York  is  certain  to  be  influential  throughout  the  whole  country  in 
forming  opinion  on  this  matter.  The  subject  should  therefore  be  considered 
on  the  broad  plan  of  the  welfare  of  the  entire  community. 

The  inquiries  made  by  the  Board  of  Education  are  not  simple  but 
involve  a  consideration  of  a  complex  question  which  must  be  taken  up  from 
at  least  three  points  of  view  which  are  quite  distinct  from  one  another, 
viz:   I.  that  of  the  school  pupils;  2.  the  teacher-mother;  3.  her  child. 

The  Pupils — On  the  ground  of  appearance  alone,  quite  apart  from  every 
other  consideration,  it  is  undesirable  to  retain  a  woman  in  her  capacity  as 
teacher  after  she  has  passed  the  sixth  month  of  her  pregnancy. 

Another  and  more  important  question  relates  to  the  efficiency  of  a 
woman  as  a  teacher  during  the  debated  period.  While  pregnancy  is  a 
physiological  process,  most  women  of  the  class  from  which  teachers  are 
drawn,  even  under  the  most  favorable  condition,  exhibit  some  impairment 
of  nervous  and  physical  efficiency  which  would  influence  their  work  as 
teachers. 

The  Mother — If  a  married  woman  be  retained  as  a  teacher  we  believe 
that  no  Board  has  the  right  to  bar  her  from  maternity.  A  consequence 
of  such  a  policy  is  to  encourage  criminal  abortion.  The  ability  of  a  woman 
to  perform  during  pregnancy  her  duties  as  a  teacher  is  an  individual  ques- 
tion. No  absolute  rule  can  be  laid  down.  It  is  the  view  of  the  committee 
that  many  women  are  incapable  of  giving  satisfactory  instruction  during 
this  period;  others  may  be  able  to  do  their  work  in  a  satisfactory  manner 
for  the  first  six  months. 

After  confinement  the  usual  time  of  return  to  her  full  school  duties 
should  be  placed  at  three  months.  Under  exceptional  conditions,  however, 
as  when  the  woman  is  the  only  wage  earner  in  the  family,  this  time  might 
be  shortened  to  six  weeks,  but  should  never  be  less,  for  the  sake  both  of 
the  mother  herself  and  her  work. 

The  Child — The  infant  also  has  rights  in  this  discussion  which  cannot 

47 


be  ignored.    We  do  not  believe  that  the  regular  routine  work  of  the  teacher- 
mother  during  pregnancy  has  any  prejudicial  effect  upon  the  child. 

The  health  of  the  child  after  it  is  born  has  much  to  do  with  the 
capacity  of  the  mother  to  do  her  work  properly.  The  time  after  confine- 
ment when  she  resumes  her  work  has  an  important  bearing  upon  the 
child's  welfare.  This  has  been  placed  at  three  months  with  the  conviction 
that  every  mother  who  can  should  nurse  her  baby  for  this  period.  If  this 
is  done,  part  nursing  can  usually  be  continued  for  a  considerably  longer 
period,  bottle  feedings  being  substituted  while  the  mother  is  in  school. 
Such  a  plan  is  entirely  feasible  and  if  well  carried  out  will  go  far  to  secure 
to  the  mother  a  strong,  healthy  infant.  On  the  other  hand,  the  absence  of  all 
maternal  nursing,  or  the  early  resort  to  bottle  feeding,  greatly  increases 
the  chances  of  a  child's  being  delicate  or  sickly.  The  care  of  such  an 
infant,  the  inevitable  loss  of  sleep  which  it  entails,  will  of  itself,  go  far  to 
render  the  mother  unfit  for  the  proper  performance  of  her  school  duties. 


PURE  FOOD  AND  PROPER  NUTRITION. 

The  problem  of  pure  food  and  proper  nutrition  has  received 
a  great  deal  of  thought  and  investigation  on  the  part  of  the  Com- 
mittee. In  1913  Commissioner  Lederle  requested  the  Committee 
to  investigate  the  food  inspection  work  of  the  Department  of 
Health.  In  view  of  the  lack  of  a  staff  of  investigators,  the  Com- 
mittee asked  the  co-operation  of  the  Bureau  of  Municipal  Research 
and  worked  out  a  detailed  schedule  of  investigation. 

The  Committee  obtained  expert  information  with  reference  to 
the  physiological  effects  of  non-nutritious  substances  in  foods  con- 
nected with  or  arising  from  methods  of  preservation.  The  Com- 
mittee pointed  out  the  need  of  standardizing  preserved  foods  and 
indicating  their  nutritive  value.  The  Committee  also  pointed  out 
the  need  of  educating  the  public  with  reference  to  the  caloric  value 
of  foods  and  the  utilization  of  certain  foods  which  are  very  in- 
expensive and  yet  contain  a  great  deal  of  nutritive  value. 

On  March  19,  1914,  a  conference  was  held  at  the  Academy  of 
Medicine  on  the  cost  of  clean  and  wholesome  food,  at  which  mat- 
ters such  as  the  relation  of  storage  to  cost  of  food,  the  responsi- 
bility of  the  consumer  and  food  cost,  the  sanitation  of  bakeries  and 
other  food  factories  and  stores  were  discussed. 

A  public  meeting  was  held  under  the  auspices  of  the  Com- 
mittee at  which  the  "Nutritive  Significance  of  Food"  and  "Food 

48 


from  the  Energy  Standpoint"  were  discussed  by  Dr.  Lafayette  B. 
Mendel  and  Dr.  Graham  Lusk.  The  two  papers  were  reprinted  by 
the  Committee  for  distribution. 


CERTIFIED  MILK. 

In  view  of  the  misconception  of  the  medical  valuation  of  certi- 
fied milk  as  evidenced  in  some  statements  of  the  public  press,  the 
Committee  has  prepared  a  statement  recording  its  estimate  of  certi- 
fied milk.  The  following  is  the  report  which  in  part  was  published 
in  the  Survey  of  May  15,  191 5. 

The  Public  Health  Committee  of  the  New  York  Academy  of  Medicine 
has  noted  recent  statements  in  the  public  press  which  seem  to  imply  a  mis- 
conception of  the  medical  valuation  of  certified  milk,  and  would  therefore, 
record  what  it  believes  to  be  the  real  medical  estimate. 

Dangers  of  Ordinary  Milk.  Milk,  as  ordinarily  handled,  is  a  food 
exposed  in  a  very  notable  degree  to  the  dangers  of  dirt  in  the  various  stages 
of  its  collection  and  transference  to  the  consumer.  The  dirt  is  always 
objectionable  for  reasons  of  decency,  and  may  be  positively  dangerous 
because  it  contains  the  micro-organism  of  one  or  another  infectious  disease. 
Until  within  a  few  years  the  only  control  exercised  over  this  food  was  the 
business  desire  of  the  producer  to  deliver  to  the  consumer  a  product  which 
should  not  be  obviously  objectionable,  and  therefore  unsalable.  Attempts 
at  cleanliness  in  production  and  in  transference  of  the  product  to  the  con- 
sumer have  been  made  with  greater  and  greater  diligence  during  the  past 
few  years.  These  attempts  have  been  inspired  partly  by  business  ambition, 
and  partly  by  the  insistence  of  physicians  and  the  public  at  large,  upon  a 
greater  degree  of  safety  in  this  food  so  generally  and  often  exclusively  used 
by  infants  and  invalids,  that  is,  by  those  in  the  condition  most  susceptible  to 
infection. 

Origin  of  Certification.  Various  milk  commissions,  made  up  of  prac- 
ticing physicians,  have  formulated  standards  with  which  milk  should  comply, 
and  have  rewarded  the  supposed  attainment  of  these  standards  by  permis- 
sion, now  legalized  in  many  places,  to  brand  the  milk  as  "certified"  by  this 
or  that  commission.  These  standards  are  not  uniform  although  they  have 
been,  it  is  believed,  invariably  an  advance  on  previously  existing  standards. 
The  product  naturally  varies  to  some  extent  with  the  standard,  and  medical 
men  generally  have  not  at  any  time  insisted  that  the  brand  "certified"  makes 
it  certain  that  the  milk  so  branded  is  without  the  possibility  of  danger. 

Maintenance  of  Standards  of  Certification.  The  standards  adopted 
by  the  various  commissions  have  related  to  the  methods  of  ordinary  clean- 

49 


liness,  to  the  production  of  milk  from  animals  free  from  disease,  and  to  the 
transference  of  the  milk  under  such  conditions  that  it  may  remain  free  from 
contact  with  disease-bearing  persons  or  utensils,  and  from  any  risk  of 
deterioration.  Compliance  with  the  standards  can  be  determined  only  by 
the  imperfect  means  of  intermittent  inspection,  and  it  cannot  be  stated  too 
strongly  that  the  advantage  of  certification  is  an  attainment  of  a  relative 
degree  of  safety  and  not  of  absolute  safety.  The  degree  of  safety  depends 
on  the  care  exercised  by  those  responsible  for  the  production  and  trans- 
portation of  the  milk,  and  on  the  character  and  amount  of  inspection.  Abso- 
lute safety  can  not  be  obtained  by  any  known  means.  Even  sterilization 
does  not  insure  it.  Milk  which,  by  reason  of  the  presence  of  dirt,  has 
undergone  bacterial  changes,  cannot  be  made  absolutely  safe  by  any  process 
of  pasteurization  or  sterilization,  for,  although  these  processes  kill  the 
disease-producing  germs,  they  do  not  destroy  the  poisons  produced  in  the 
milk  by  the  bacteria  before  they  were  killed.  It  is  the  present  medical 
belief  that  a  combination  of  pasteurization  with  inspection,  such  as  is 
required  in  certified  milk  production,  presents  the  highest  degree  of  safety 
for  milk  now  attainable. 

Use  of  Raw  Milk.  It  is,  however,  also  believed  that  certain  infants  are 
nourished  more  successfully  on  milk  which  has  not  undergone  pasteurization, 
and  that  it  is  therefore  desirable  that  milk  should  be  provided  in  as  clean 
a  condition  as  possible,  and  accordingly  as  fit  as  possible  for  use  without 
pasteurization.  Such  milk  can  be  obtained  only  from  reputable  contractors 
and  through  faithful,  frequent,  and  intelligent  inspection,  and  is  invariably 
expensive  as  compared  with  milk  not  so  guarded. 

Certified  Milk  in  New  York  City.  In  New  York  City  "certified" 
milk  means  usually  milk  "certified  by  the  Milk  Commission  of  the  Medical 
Society  of  the  County  of  New  York"  which  is  a  Commission  composed 
of  physicians  appointed  by  the  President  of  the  County  Medical  Society. 
The  standards  set  by  this  Commission  relate  especially  to  cleanliness  of  the 
milk  which  can  be  judged  approximately  by  the  bacterial  content,  at  present 
determined  weekly,  the  amount  of  fat  in  the  milk,  which  is  tested  by 
chemical  analysis,  the  absence  of  tuberculosis  and  disease  of  the  udder  in 
the  cows  producing  the  milk,  and  the  absence  of  disease  in  those  who  handle 
the  cows  and  the  milk.  The  control  of  cleanliness  is  exercised  chiefly  by 
inspection  made  by  paid  experts  at  regular  intervals,  averaging  once  in 
three   weeks. 

Detection  of  Tuberculosis  in  Cattle.  The  presence  of  tuberculosis 
in  cattle  is  now  investigated  by  injecting  the  animals  in  a  prescribed  manner 
with  tuberculin  and  then  taking  the  temperature  of  the  animals  at  regular 
intervals  for  a  prescribed  period  to  determine  whether  fever  does  or  does 
not  develop  as  a  result  of  the  injection.  A  characteristic  fever  is  regarded 
as  indicative  of  tuberculosis.  This  test,  now  in  use  for  many  years,  has 
been  modified  considerably  since  its  introduction,  and  may  be  modified  yet 

50 


further,  or  some  other  test  may  come  to  be  regarded  as  more  convenient 
or  reliable.  The  length  of  time  during  which  the  temperature  should  be 
repeatedly  taken  is  one  of  the  still  uncertain  factors  of  the  test,  but  the 
former  medical  belief  that  eighteen  hours  is  a  sufficient  period  has  yielded, 
as  a  result  of  observation,  to  the  present  demand  for  twenty-four  hours. 
Observation  too  has  shown  a  need  not  formerly  recognized  for  a  more  fre- 
quent tuberculin  test,  but  those  most  experienced  differ  in  their  recommenda- 
tions as  to  the  proper  interval  between  tests.  The  present  practice  follows 
the  medical  recommendation  that  a  test  shall  be  administered  to  every  animal 
within  one  month  previous  to  admission  to  a  dairy  herd,  and  that  thereafter 
a  test  shall  be  made  annually,  and  if  reactors  are  found  in  a  herd,  shall  be 
repeated  in  six  months.  Excellent  authorities,  however,  believe  that  a 
test  every  six  months  should  be  the  routine  practice.  These  examinations 
provide  a  great  safeguard  against  tuberculosis,  but  as  they  depend  on  the 
honesty  of  agents,  they  are  not  infallible.  A  single  performance  of  the 
tuberculin  test  puts  the  animal  for  a  time  in  such  a  condition  that  it  may 
not,  after  a  second  injection,  even  if  tuberculous,  develop  a  characteristic 
fever.  The  duration  of  the  period  during  which  a  second  test  is  unreliable 
is  at  present  uncertain.  It  is,  however,  clear  that  repetition  of  this  test 
after  too  short  an  interval  may  not  show  an  existing  infection  and  may 
therefore  give  a  false  sense  of  security. 

Typhoid  fever,  scarlet  fever  and  diphtheria  have  occasionally  been  com- 
municated (though  as  far  as  known  not  in  New  York  City)  by  certified  milk, 
which  has  been  exposed  after  bottling  to  persons  suffering  from  these 
diseases,  and  infectious  sore  throat  has  been  communicated  through  milk 
from  cows  suffering  from  an  infection  of  the  udder.  Inspection  cannot  en- 
tirely remove  these  possibilities,  but  precautions  exercised  by  conscientious 
contractors  may  reduce  them  to  a  minimum.  The  milk  rated  by  the  New 
York  City  Health  Department  as  "Grade  A  Raw"  differs  from  "certified" 
milk  chiefly  in  being  less  controlled  by  inspections. 

The  Medical  Estimate  of  Certified  Milk.  The  present  medical  belief 
is  that  certified  milk  is  the  safest  raw  milk  to  be  obtained,  but  that  the  safety 
of  such  milk  depends  upon  the  standards  of  certification,  the  amount  and 
character  of  the  inspection,  and  the  precautions  adopted  to  exclude  diseased 
animals  and  to  protect  the  milk  from  contamination  by  diseased  human 
beings  and  from  deterioration  in  transit.  Finally,  it  is  believed  that  pas- 
teurization of  certified  milk  provides  an  additional  safeguard.  It  is  under- 
stood that  the  maintenance  of  precautions  against  these  dangers  is  the 
special  function  of  the  milk  commissions. 

TURBIDITY  OF  THE  CROTON  WATER. 

When  during  the  summer  of  19 12  the  Croton  water  supply 
became  turbid,  the  Committee  inquired  into  the  cause  of  it  and 
ascertained  that  the  discoloration  of  the  water  was  due  to  the  fact 

51 


that  on  the  Croton  water  shed  there  were  large  areas  in  which  the 
soil  has  been  broken  up  and  pulverized  with  fine  silt  of  top  soil 
by  cultivation.  This  fine  material  is  carried  by  the  water  when 
the  reservoirs  are  low,  and  this  accounted  for  the  turbidity  of  the 
water  supply  in  the  summer  of  1912. 

The  Committee  also  ascertained  that  the  water  had  been  an- 
alyzed daily,  treated  with  the  hypochlorid  of  lime  and  was  free 
from  pathogenic  organisms. 


SEWAGE  DISPOSAL  INTO  MOHANSIC  LAKE. 

At  the  request  of  the  City  Commissioner  of  the  Department 
of  Water  Supply,  Gas  and  Electricity,  the  Committee  gave  care- 
ful consideration  to  the  matter  of  discharging  sewage  from  the  two 
recently  built  institutions  (State  Hospital  for  the  Insane  and  the 
Yorktown  Training  School  for  Boys)  into  Mohansic  Lake.  After 
carefully  weighing  the  arguments  for  and  against  such  a  procedure, 
the  Committee  took  the  stand  that  inasmuch  as  doubt  exists  as 
to  the  certainty  of  rendering  sewage  effluent  harmless,  it  would  be 
unwise  to  add  a  possible  source  of  pollution  to  the  Croton  Water 
Supply  and  recommended  the  alternative  of  draining  the  sewage 
into  the  Hudson  River  which,  according  to  the  estimates  of  the 
Department  of  Water  Supply,  Gas  and  Electricity,  could  be  done 
at  a  cost  of  $120,000.  The  Committee  felt  that  such  a  relatively 
small  expenditure  of  money  should  not  stand  in  the  way  of  an 
absolutely  safe  method  of  sewage  disposal. 


SANITARY  ASPECTS  OF  THE  SUBWAY. 

In  1913  when  the  plans  for  the  new  subways  had  been  con- 
sidered, the  Committee  called  to  the  attention  of  the  Public  Service 
Commission,  the  Department  of  Health,  the  Board  of  Estimate 
and  Apportionment,  and  the  members  of  private  public  health 
agencies  of  the  City  to  the  need  of  so  planning  the  projected  sub- 
ways as  to  provide  for  adequate  ventilating  and  cleaning  facilities, 
for  a  reduction  of  the  noise  in  the  subways  and  for  the  construction 


52 


of  sanitary  comfort  stations,  arranged  in  such  a  way  that  they 
may  be  available  for  the  use  of  the  patrons  of  the  subway  and  for 
others  as  well. 

STREET  ACCIDENTS. 

Very  little  attention  has  been  paid  by  those  interested  in  pub- 
lic health  to  the  matter  of  street  accidents  and  no  attempts  on  their 
part  have  been  made  to  find  out  accurately  the  extent  of  this 
source  of  mortality  and  injury  of  the  population  of  the  City,  al- 
though the  deaths  from  street  accidents  exceed  those  from  typhoid 
fever.  To  stimulate  interest  in  this  important  matter  the  Commit- 
tee has  made  a  study  of  the  available  statistics  of  street  accidents 
occurring  in  the  City  of  New  York.  It  was  found  that  during  the 
year  191 5  the  total  number  of  accidents  was  22,540  of  which  659 
were  fatal.  The  report  prepared  gives  an  analysis  of  the  statistics 
by  ages,  by  sexes  and  by  the  months  in  which  the  accidents  oc- 
curred. It  also  gives  the  chief  causes  of  the  accidents  caused  by 
special  types  of  vehicles,  such  as  ambulances,  fire  engines,  mail 
wagons,  busses,  etc.  Although  the  total  number  of  accidents  caused 
by  these  vehicles  is,  in  the  opinion  of  the  Police  Department,  too 
small  to  warrant  separate  headings,  at  the  request  of  the  Com- 
mittee such  statistics  were  obtained  for  the  month  of  February  of 
this  year  and  an  analysis  showed  that  out  of  the  total  of  1,407 
highway  accidents,  only  two  were  caused  by  ambulances,  one  by 
fire  engines,  three  by  busses  and  five  by  mail  wagons. 

The  Committee  recommended  to  the  Department  that  in  view 
of  certain  misapprehensions  existing,  it  would  be  desirable  to  ana- 
lyze the  statistics  in  greater  detail  than  has  been  done  hitherto,  and 
also  to  give  more  newspaper  publicity  to  the  whole  question  of 
street  accidents  as  a  step  toward  the  prevention  of  street  accidents 
through  the  education  of  the  public. 

HEALTH  INSURANCE. 

The  matter  of  social  health  insurance  has  received  thorough 
consideration  on  the  part  of  the  Committee.  Recommendations 
were  made  to  the  Special  Committee  of  the  American  Association 

53 


for  Labor  Legislation  at  whose  invitation  the  Committee  interested 
itself  in  the  matter.     The  Recommendations  were: 

1.  Provision  should  be  made  for  periodic  medical  examination  of  all 
persons  insured  under  the  Act.  If  this  be  impossible  of  introduction  at 
the  outset,  provision  should  be  made  to  compensate  those  who  voluntarily 
submit  to  examinations,  either  by  a  reduction  in  their  premiums  or  an 
increase   in   their  benefits. 

2.  Medical,  surgical  and  nursing  aid  should  be  afforded  to  the  wives 
and  children  of  insured  persons.  The  inclusion  of  dependent  wives  and 
children  as  beneficiaries  under  the  Health  Insurance  Act  would  advance 
materially  public  health,  as  many  infectious  diseases  would  early  be  dis- 
covered and  reported,  and  early  home  quarantine  enforced. 

3.  Close  co-operation  with  the  State  and  Local  health  authorities  should 
be  established,  for  example  by  making  the  State  Commissioner  of  Health 
a  member  of  the  State  Insurance  Board  and  the  sanitary  supervisors  mem- 
bers of  district  insurance  committees ;  also.  Health  Officers  of  the  cities  and 
towns  might  be  members  of  the  local  supervising  insurance  authorities. 

4.  Utilization  of  existing  dispensaries  for  the  administration  of  medical 
benefits  in  cities  well  provided  with  institutions  of  this  type  should  be 
encouraged.  Arrangements  made  by  insurance  carriers  with  dispensaries 
for  the  care  of  the  insured  in  certain  sections  would  enable  the  dispensaries 
to  increase  their  efficiency  and  would  provide  controlled  medical  service. 
Ambulatory  cases  would  be  treated  at  the  dispensaries,  and  other  cases  could 
be  cared  for  in  their  homes  by  visiting  physicians  and  nurses  under  proper 
control.  Both  physicians  and  nurses  would  be  compensated  at  a  rate  uni- 
form to  all  dispensaries,  out  of  the  proceeds  received  by  the  institutions 
from  the  insurance  carriers.  The  equipment  of  the  dispensaries  would  make 
possible  proper  care  of  patients  requiring  special  therapeutic  facilities  and 
apparatus.  Through  this  means  the  patients  would  also  be  able  to  obtain 
services  of  specialists  in  various  branches  of  medicine  without  increased  cost 
to  themselves  and  to  the  insurance  carriers.  Such  a  scheme  would  also  be 
beneficial  to  the  advancement  of  medical  science  through  carefully  super- 
vised work  and  through  the  keeping  of  exact  records. 

5.  Where  physicians  practice  under  the  Act  outside  of  dispensaries 
and  in  localities  where  no  dispensaries  exist,  arrangements  for  medical  and 
surgical  care  should  be  made  through  the  State  medical  society  or  the  vari- 
ous county  medical  societies  who  would  assume  responsibility  over  the 
medical  work  performed  by  the  physicians.  Payment  by  the  insurance 
carriers  should  be  made  through  such  State  or  county  societies  to  the  in- 
dividual physicians  in  accordance  with  the  services  rendered.  Such  arrange- 
ment would  also  provide  for  adequate  medical  control  in  the  prevention  of 
malingering,  which  has  been  universally  recognized  as  a  serious  deterrent 
to  efficient  health  insurance  administration. 

6.  The  administrative  scheme  adopted  for  carrying  out  the  medical 
provisions    of    the    Act    should    prevent    the    drafting    into    the    service    of 


54 


graduates  of  less  than  three  years'  standing  unless  they  have  had  at  least 
one  year  of  hospital  service. 

Care  should  also  be  taken  that  the  provisions  of  this  Act  do  not  tend 
to  keep  at  home  patients  who  need  hospital  treatment. 

Administrative  arrangements  should  be  of  such  a  nature  as  to  compen- 
sate through  the  management  of  the  hospitals  the  physicians  attending 
insured  persons  in  institutions. 

7-  The  effect  of  the  legislation  advised  should  be  such  as  not  to  lower 
the  present  economic  status  of  the  medical  profession. 

It  is  very  probable  that  certain  objections  will  be  raised  to  these  recom- 
mendations. The  Committee  have  considered  this  and  still  feel  that  such 
objections  are  overbalanced  by  the  arguments  in  favor  of  the  recom- 
mendations. 


55 


VI 


MLDICAL,  PUBLIC  HEALTH,  DENTAL  AND 
NUR5ING  EDUCATION 


PUBLIC  HEALTH  INSTRUCTION  IN  MEDICAL  SCHOOLS. 

In  the  course  of  the  Committee's  various  activities  and  studies 
it  has  been  apparent  that  however  good  the  intentions  of  the  City 
and  State  and  however  willing  the  body  of  private  citizens  which 
undertakes  public  health  activities,  their  efforts  prove  unneces- 
sarily expensive,  and  in  certain  instances  futile,  because  of  the  lack 
of  trained  experts,  sanitarians,  public  health  physicians  and  social 
workers  to  carry  out  the  admirable  and  altogether  possible  plans 
which  they  wish  to  put  into  force.  The  supply  of  such  experts, 
as  we  find  a  dearth  of  and  a  need  of,  can  come  only  from  among 
the  graduates  in  medicine  or  sanitary  engineering,  who  are  trained 
especially  by  post-graduate  courses  in  existing  universities  and 
medical  schools  in  this  country. 

The  Committee  made  a  review  of  the  courses  offered  in  the 
various  universities  leading  to  a  degree  of  doctor  or  master  of 
public  health.  The  courses  were  found  to  be  excellent  but  not 
sufficiently  inclusive.  Subjects  such  as  the  principles  of  organiza- 
tion and  administration  of  public  health  departments,  efficiency 
methods  and  practices,  applied  sociology  and  social  legislation,  the 
technicalities  of  budget  making,  and  the  preparation  of  statistics 
and  reports,  are  not  included  in  the  curricula  of  the  schools. 

In  view  of  this  the  Committee  worked  out  a  plan  of  study 
which  would  meet  the  manifold  requirements,  and  submitted  it  to 
the  Council  on  Medical  Education  of  the  American  Medical  Asso- 
ciation, and  also  the  deans  of  the  medical  schools  of  the  City  of 

56 


New  York.  As  a  consequence  plans  for  public  health  instruction 
are  being  discussed  in  the  several  medical  schools  with  a  view 
to  the  early  establishment  of  courses.  A  School  of  Hygiene  and 
Public  Health  has  recently  been  established  at  the  Johns  Hopkins 
Medical  School  at  Baltimore  under  a  grant  from  the  Rockefeller 
Foundation. 

AUTOPSIES. 

In  co-operation  with  the  Russell  Sage  Institute  of  Pathology, 
the  Committee  investigated  the  extent  of  performance  of  autopsies 
in  the  main  hospitals  in  this  country  and  abroad.  From  the  study 
it  became  apparent  that  the  small  number  of  autopsies  performed 
in  our  hospitals,  despite  the  efforts  made  by  many  to  obtain  per- 
missions for  performing  them,  proves  very  forcibly  that  some 
changes  in  the  public  mind  and  in  the  existing  laws  must  be  brought 
about  in  order  that  medical  education  and  medical  progress  in  this 
country  may  not  be  seriously  hampered. 

With  this  in  view  the  Committee  recommended: 

1.  That  effort  be  made  on  the  part  of  various  medical  bodies 
to  interest  the  press  in  the  matter  of  autopsies  with  a  view  of 
presenting  to  the  public  the  absolute  dependence  of  medical  progress 
and  education  on  the  regular  performance  of  post-mortem  exam- 
inations ; 

2.  That  effort  be  made  to  secure  legislation  relative  to  autop- 
sies, similar  to  that  of  European  countries,  which  would  obviate 
the  necessity  of  securing  written  permissions  and  at  the  same  time 
safeguard  all  the  present  rights  of  the  relatives ; 

3.  That  the  law  should  be  so  amended  as  to  recognize  the 
difference  between  anatomic  dissection  and  pathologic  autopsy  made 
for  scientific  purposes; 

4.  That  until  such  legislation  is  secured,  the  boards  of  mana- 
gers of  all  our  private  hospitals  be  urged  to  have  the  hospital  rules 
so  changed  as  to  remove  as  much  as  possible  the  obstacles  now 
placed  in  the  way  of  securing  autopsies. 

Following  the  publication  of  the  report  in  the  Journal  of  the 
American  Medical  Association  of  June  7,  191 3,  attempts  were  made 
to  put  the  recommendations  of  the  Committee  into  effect. 

57 


Efforts  have  since  been  made  to  interest  hospital  trustees  and 
other  hospital  officers  in  this  subject,  in  order  that  they  may  better 
appreciate  the  handicap  to  medical  progress  that  results  from  the 
small  percentage  of  autopsies  obtained  in  the  hospitals.  Frequent 
conferences  have  been  held  with  representatives  of  several  hos- 
pitals, as  well  as  of  the  pathological  and  anatomical  departments  of 
the  medical  schools,  in  an  effort  to  draft  a  bill  for  the  State 
Legislature  which  would  embody  the  recommendations  made  by  the 
Committee. 


THE  CORONERS. 

The  New  York  Academy  of  Medicine  at  various  times  in  the 
last  twenty  years  has  gone  on  record  as  opposed  to  the  present 
coroner's  system.  During  1914  the  Committee  revived  the  discus- 
sion of  the  matter  and  has  arranged  a  series  of  conferences  on  the 
subject  at  the  Academy. 

It  has  actively  assisted  in  the  formulation  of  a  bill  providing 
for  the  abolition  of  the  office  of  coroner,  which  was  introduced 
in  the  Legislative  Assembly  in  19 14  but  failed  of  passage. 

The  matter  was  subsequently  taken  up  by  the  Commissioner 
of  Accounts  of  the  City  and  a  thorough  investigation  has  been 
conducted  by  his  office.  The  Committee  co-operated  with  the  com- 
missioner and  was  represented  at  the  hearing  held  in  Albany 
during  the  session  of  the  Legislature  in  191 5. 

The  bill  abolishing  the  coroner's  office  was  passed  and  begin- 
ning with  1918  special  well  qualified  medico-legal  officers  will  be 
in  charge  of  the  cases  that  hitherto  came  under  the  coroner's 
jurisdiction. 

FIFTH  MEDICAL  YEAR. 

Over  a  year  ago  the  attention  of  the  Public  Health  Committee 
was  called  by  the  Department  of  Health  of  this  City  to  the  need 
of  amending  the  laws  of  the  State  in  such  a  way  as  to  afford  pro- 
tection to  the  public  from  incompetent  physicians.     It  was  sug- 


58 


gested  that  legislation,  similar  in  principle  to  that  of  Pennsylvania, 
Rhode  Island  and  New  Jersey  should  be  enacted,  demanding  at 
least  a  year  of  hospital  experience  from  all  candidates  for  medical 
licensure.  Before  attempting  to  advise  legislation  of  this  sort  the 
Committee  endeavored  to  find  out  how  many  prospective  physi- 
cians failed  to  secure  such  experience  before  entering  into  the  prac- 
tice, and  also  what  would  be  the  attitude  of  the  medical  schools  of 
the  State  toward  such  an  amendment  to  the  law. 

From  the  statistics  available  it  was  ascertained  that  a  large 
proportion  of  medical  students  of  New  York  State  secure  hospital 
positions  immediately  after  graduation.  It  was  also  ascertained 
that  those  who  do  not  receive  hospital  appointments  do  not  fail  to 
do  so  because  of  any  lack  of  hospital  accommodations  in  this  State, 
but  because  of  the  character  of  the  applicants  or  on  account  of 
their  economic  status,  which  forbids  them  from  delaying  any  longer 
than  they  are  legally  obliged  to  do  so,  their  entrance  into  practice. 

The  attitude  of  the  schools  was  unanimously  favorable  toward 
the  principle  of  requiring  a  minimum  of  a  year  of  hospital  experi- 
ence of  an  educational  character,  but  numerous  difficulties  were 
pointed  out  in  the  realization  of  such  a  plan.  The  foremost  diffi- 
culty is  the  lack  of  standardization  of  hospitals ;  a  second  is  the 
relation  of  the  school  to  the  hospital.  A  year's  hospital  experience 
may  mean  much  or  little,  the  pivotal  point  being  efficiency  in  the 
organization  of  the  hospital.  Then,  many  medical  schools  have  no 
control  over  hospitals  and  they  are  loath  to  have  their  students 
pursue  so  important  a  part  of  their  medical  education  outside 
of  the  control  of  the  faculty.  It  is  feared  that  in  some  instances 
students  would  work  under  the  guidance  of  men  not  properly  quali- 
fied to  teach.  Some  of  the  schools  feel  that  should  a  fifth  year 
be  added  it  should  not  be  given  over  entirely  to  clinical  work,  but 
that  the  curriculum  of  the  school  should  be  recast  and  the  clinical 
Avork  distributed  over  two  or  three  years,  and  that  in  a  part  of  the 
fifth  year  certain  theoretical  studies  be  pursued.  It  was  also  point- 
ed out  that  many  students  do  not  intend  to  practice,  but  prepare 
to  take  up  laboratory  work  and  that  they  should  not  be  compelled 
to  take  a  year  of  clinical  work  in  a  hospital. 

Realizing  that  many  of  these  objections  were  valid,  the  Com- 
mittee, after  conferences  with  the  deans  of  some  of  the  medical 
schools  and  the  Assistant  Commissioner  of  the  State  Department 

59 


of  Education  proposed  a  simple  amendment,  which  retained  the 
essential  principle,  but  which  was  so  worded  as  to  allow  sufficient 
elasticity  to  meet  the  various  plans  which  the  medical  schools  might 
wish  to  adopt.  The  proposal  provided  that  in  addition  to  meeting 
existing  requirements,  an  applicant  may  apply  for  a  license, 
only  after  completing  twelve  months  of  satisfactory  clinical  work 
in  a  hospital  having  a  daily  average  of  not  less  than  thirty  patients 
and  having  not  less  than  fifty  beds  devoted  to  the  treatment  of 
medical  and  surgical  diseases  and  registered  by  the  Regents  as 
maintaining  at  the  time  satisfactory  clinical  and  laboratory  stand- 
ards. 

The  proposal  made  in  no  way  affects  the  granting  of  the 
medical  degree ;  the  twelve  months  of  clinical  work  may  or  may 
not  be  included  in  the  college  curriculum,  according  to  the  judg- 
ment and  desire  of  college  authorities ;  the  student  will  be  free  if 
he  chooses,  to  do  a  large  part  of  the  required  clinical  work  during 
his  second  and  third  college  vacations  and  therefore,  the  entry 
of  the  student  into  practice  need  not  be  long  deferred.  Under  the 
law  as  proposed,  a  college  may  or  may  not  add  a  fifth  year  to  its 
curriculum,  but  at  all  events,  the  public  will  be  protected  by  the 
requirement  that  each  applicant  for  a  license  shall  spend  at  least 
twelve  months  in  clinical  work  before  coming  up  for  examination. 
Those  who  do  not  intend  to  practice  medicine  need  not,  of  course, 
take  the  examination  for  licensure  but  if  they  should  at  any  fu- 
ture time  decide  to  take  up  the  practice  of  medicine  they  will  be 
compelled  to  meet  this  requirement  of  a  year  of  clinical  experience. 
This  requirement  will  be  applicable  to  graduates  of  schools  in  other 
States  and  the  law,  therefore,  will  not  impose  a  handicap  on  the 
medical  colleges  of  New  York  to  the  advantage  of  competing 
schools  elsewhere. 

The  Committee  avoided  any  attempt  to  define  "satisfactory" 
hospital  standards,  believing  it  wise  to  permit  the  Regents  to  feel 
their  way  in  this  new  field,  guided  by  the  authorities  of  the  medical 
schools.  The  proposal  that  the  hospitals  in  which  clinical  work  is 
done  shall  maintain  "satisfactory"  clinical  and  laboratory  stand- 
ards corresponds  to  that  part  of  the  present  law  which  declares 
that  the  professional  requirement  shall  include  four  "satisfactory" 
courses  in  medical  schools  maintaining  "satisfactory"  standards. 


60 


One  of  the  medical  schools  in  this  State  has  objected  to  this 
proposed  amendment  on  the  ground  that  it  compels  the  applicant 
for  a  license  to  keep  fresh  in  his  mind  for  another  year  the  in- 
formation necessary  to  pass  the  present  style  of  examination.  In 
this  respect  the  College  referred  to  stands  alone ;  all  the  others 
have  endorsed  the  recommendation  fully  and  some  went  so  far 
as  to  advocate  even  more  rigid  requirements. 

In  view  of  the  fact  that  the  State  Medical  Society  of  New 
York  has  planned  to  devote  one  of  the  sessions  of  its  annual 
meeting  to  the  subject  of  medical  legislation,  the  Committee  voted 
to  submit  this  proposal  for  the  consideration  of  the  Society  and 
to  get  the  benefit  of  its  opinion  concerning  the  matter.  It  has 
been  submitted  to  Dr.  W.  Stanton  Gleason,  President  of  the  So- 
ciety, and  has  received  the  careful  consideration  and  unanimous 
approval  of  the  Society  at  the  meeting  in  Saratoga  on  May  i6, 
1916.  No  changes  have  been  suggested  in  the  amendment  as  sub- 
mitted. It  is  probable  that  legislation  along  the  lines  suggested  by 
the  Committee  will  be  enacted  into  the  law  of  the  State  in  the  near 
future  and  will  redound  to  the  benefit  of  the  public  as  well  as  to 
the  medical  profession. 

DENTAL  EDUCATION. 

The  matter  of  the  present  status  of  the  dental  schools  in  this 
City  and  State  and  the  desirability  of  recommending  the  establish- 
ment of  universities  and  schools  of  dentistry  was  taken  up  by  the 
Committee  and  an  investigation  of  the  situation  was  made. 

A  report  has  been  prepared  and  the  conclusion  reached  that 
there  is  a  distinct  need  of  additional  dental  colleges  in  this  City 
which  it  would  be  preferable  to  establish  in  connection  with  uni- 
versities having  medical  schools. 

The  following  is  the  report : 

There  are  three  dental  schools  in  the  State  of  New  York,  two  in  New 
York  City,  the  College  of  Dental  and  Oral  Surgery  and  the  New  York  Col- 
lege of  Dentistry,  and  the  third  in  Buffalo,  conducted  under  the  auspices  of 
the  University  of  Buffalo. 

The  New  York  College  of  Dentistry  is  the  oldest  and  largest,  having 
been  established  in  1886  and  registering  845  students,  male  only,  for  the 
present  year,  326  freshmen,  274  juniors  and  245  seniors.     Since  the  death 


61 


of  Dr.  Weisse  last  year,  Dr.  Alfred  R.  Starr  has  been  Dean.  The  main 
building  and  the  annex  occupied  by  the  school  are  inadequate  to  accommo- 
date all  the  applicants.  About  70  were  refused  admission  last  year.  The 
College  is  proprietary,  having  no  endowment.  The  tuition  fee  is  $200,  and 
the  proceeds  from  the  fees  more  than  cover  the  costs  of  maintaining  the 
institution.  The  college  is  endeavoring  to  raise  money  for  a  new  building 
in  East  42nd  Street  where  it  owns  a  considerable  piece  of  property. 

The  College  of  Dental  and  Oral  Surgerj',  founded  and  conducted  by 
Dr.  William  Carr  occupies  a  new  and  well  equipped  building  in  East  35th 
Street.  Its  registration  is  over  500  students,  both  sexes,  and  owing  to  the 
limitation  of  facilities,  they  too  have  been  compelled  to  refuse  50  applicants 
last  year.  This  school  is  also  proprietary,  having  no  endowment  and  the 
tuition   fee  is   similar,  $200. 

The  Buffalo  School  obtained  its  charter  in  1892  and  now  has  an  enroll- 
ment of  about  500  students. 

At  the  present  time  the  course  is  three  years,  but  beginning  with  the 
1917  session  all  the  Colleges  holding  membership  in  the  National  Associa- 
tion of  Dental  Faculties  have  agreed  to  adopt  the  four  years'  course.  This 
means  that  all  the  schools  in  this  State  will  have  a  four  years'  course.  The 
additional  year  will  make  possible  a  more  thorough  education  in  the  funda- 
mental sciences. 

The  requirements  for  admission  to  the  schools  of  dentistry  in  the  State 
are  either  possession  of  a  high  school  diploma  or  an  equivalent  certified 
to  by  the  Board  of  Regents.  Persons  holding  an  M.  D.  degree  are  admitted 
and  may  complete  their  work  in  two  years. 

In  addition  to  the  purely  technical  work  required  in  dentistry,  the  cur- 
riculum includes  Instruction,  chiefly  by  lecture,  in  anatomy,  pathology,  bi- 
ology, histology  and  bacteriology ;  X-ray  photography,  the  use  of  the  micro- 
scope ;  laboratory  work  in  chemistry  and  metallurgy ;  and  practical  instruction 
in  oral  surgery,  pathology,  therapeutics  and  materia  medica. 

The  college  clinics  receive  many  patients  and  the  work  is  done  under 
the  guidance  of  instructors.  The  New  York  College  has  a  small  infirmary, 
work  in  which  is  optional. 

The  Deans  of  the  two  Colleges  in  the  City  expressed  the  opinion  that 
there  is  a  need  for  another  school  in  this  City.  Both  favored  University 
connections  for  their  own  schools  and  stated  that  in  case  such  connections 
latitude,  and  would  also  wish  to  protect  the  present  members  of  their 
were  made  they  would  wish  to  reserve  for  themselves  a  certain  degree  of 
Faculties,  who  have  served  them  faithfully  and  efficiently  in  the  past. 

In  view  of  the  fact  that  the  schools  are  overcrowded,  and  in  view  of 
the  further  fact  that  many  New  York  students  seek  instruction  in  university 
schools  outside  of  the  State,  fout  of  the  enrollment  of  722  at  the  School  of 
Dentistry  of  the  University  of  Pennsylvania,  206  or  about  30  per  cent,  come 
from  New  York  State)  there  seems  to  be  a  well  recognized  need  for  an 
additional  school,  preferably  in  connection  with  a  university. 

The  only  information  which  could  be  obtained  regarding  dental  schools 

62 


under  university  control  was  with  regard  to  the  Philadelphia  School,  the 
Harvard  University  School,  the  University  of  Maryland  School  in  Balti- 
more and  the  Ann  Arbor  School. 


NURSING  EDUCATION. 

The  matter  of  the  training  of  nurses  has  received  a  great  deal 
of  attention  on  the  part  of  the  Committee.  Numerous  conferences 
with  representatives  of  hospitals,  training  schools,  and  agencies 
interested  in  public  health  were  held.  In  view  of  the  fact  that 
there  is  no  uniformity  of  standards  among  the  training  schools  and 
that  the  requirements  for  nursing  education  are  at  great  variance 
in  the  several  states  of  the  Union,  and  also  in  view  of  the  fact  that 
the  fields  of  usefulness  of  the  nurses  have  become  broadened  and 
require  special  training,  in  1914  the  Committee  recommended  to 
the  Carnegie  Foundation  for  the  Advancement  of  Teaching,  the 
urgent  need  of  a  comprehensive  study  of  the  problems  of  Nursing 
Education.  At  that  time  the  Carnegie  Foundation  was  not  able 
to  undertake  it.  Recently,  Mr.  Pritchard,  the  President  informed 
the  Committee  that  the  Foundation  had  undertaken  such  a  study  in 
co-operation  with  the  American  College  of  Surgeons. 

The  Committee  had  also  under  advisement  the  question  of 
legislation  in  regard  to  the  Practice  of  Nursing.  The  Bill  intro- 
duced into  the  State  Legislature  during  the  session  of  1912  was 
opposed  by  the  Committee  because  of  the  attempt  to  copyright  the 
term  "Nurse"  and  to  make  it  apply  only  to  graduates  of  registered' 
nurses'  training  schools.  The  majority  of  the  Committee,  however, 
was  in  favor  of  the  principle  of  the  bill  which  aimed  at  securing 
greater  protection  for  the  profession  of  trained  nurses  and  of  the 
public  at  large.  When  a  new  bill  was  introduced  in  19 16  free  from 
the  objections  raised  by  the  Committee  in  the  past,  the  Committee 
voted  to  support  it. 


63 


VII 


THL  CARL  OF  THE,  MENTALLY  DLFLCTIVL, 
THL  DLLINQULNT  AND  THL  AGED 


CARE  OF  THE  MENTALLY  DEFECTIVE. 

One  of  the  problems  which  has  received  a  very  large  amount 
of  time  and  consideration  on  behalf  of  the  Committee  was  the 
problem  of  the  segregation  and  care  of  the  mentally  defective.  The 
lack  of  adequate  control  over  this  class  of  unfortunates  and  the 
serious  social  consequences  that  this  lack  of  control  entails  led  the 
Committee  to  investigate  the  matter  in  a  very  thorough  fashion 
and  to  formulate  a  series  of  recommendations. 

The  discrepancy  between  the  number  of  feeble  minded  in  this 
State  and  the  facilities  for  institutional  care  of  them  is  so  large  as 
to  make  the  matter  one  of  grave  public  concern. 

The  plan  as  formulated  by  the  Committee  embraces  the  policy 
of  procedure  which  covers  the  whole  life  of  the  feeble  minded. 
The  Committee  believes  that  some  such  program  must  be  adopted 
in  order  to  combat  the  situation  effectively.  The  following  is  the 
program  outlined  by  the  Committee  and  published  in  the  Survey 
of  June  21,  1913: 

"We  believe  that  the  interests  of  the  state  and  of  the  individuals  con- 
cerned would  be  best  served  if  the  care  of  the  feeble  minded  should  be 
dealt  with  as  follows :  namely,  That  the  organization  of  a  State  Board  of 
Control,  analogous  in  function  to  the  State  Board  of  Lunacy,  be  so  author- 
ized by  law  that  it  shall  be  empowered  to  have  charge  of  all  feeble  minded 
from  birth  to  death  with  the  exception  of  that  part  of  the  lives  of  the 
educable  feeble  minded  which  comes  within  the  usual  school  ages  in  such 
municipalities  as  make  proper  provision  for  the  training  of  the  feeble  minded. 

Before  school  age  the  care  of  the  feeble  minded  would  naturally  fall 

64 


to  the  family  under  the  supervision  of  such  a  state  board,  with  the  addi- 
tional observation  of  specifically  qualified  private  agencies. 

Race,  religion  and  economic  status  should  not  relieve  the  family  from 
the  supervision  of  state  authorities  or  the  restrictions  vi^hich  might  be  neces- 
sary to  be  imposed  for  the  public  welfare.  During  this  period  the  records 
should  be  made  which  should  be  permanently  under  the  State  Board  of 
Control  or  under  some  State  Bureau  of  Statistics  if  such  should  later  be 
established. 

During  school  age  all  educable  children  should  be  educated  as  far  as 
possible  to  be  self-supporting  if  possible,  either  by  private  means,  or  in 
existing  public  schools,  or  in  special  institutions  if  they  are  later  provided. 
During  school  age  the  children's  records  should  still  be  kept  up  and  form  a 
part  of  the  permanent  files  of  the  State  Board  of  Control. 

After  school  age  the  feeble  minded  who  are  non-selfsupporting  should 
be  cared  for  by  the  State  or  by  private  means  under  State  supervision. 
Those  who  are  self-supporting  might  be  allowed  under  certain  restrictions 
to  live  outside  of  institutions,  but  it  would  be  the  ultimate  ideal  to  so 
supervise  all  feeble  minded  in  or  out  of  State  institutions  that  propagation 
of  their  kind  may  be  prevented. 

In  order  that  this  may  become  a  fact  and  not  merely  a  hope,  it  is 
probable  that  some  kind  of  custodial  care  for  women  and  men  in  farm 
colonies  will  have  to  be  provided. 

The  criminal  feeble  minded  should  be  referred  by  the  courts  to  the 
State  Board  of  Control,  rather  than  to  reformatories  or  prisons  for  criminals, 
for  detention  and  care,  separate  from  the  feeble  minded  who  have  no  anti- 
social tendencies. 

We  believe  that  there  is  now  and  will  be  for  some  time,  and  probably 
always,  a  need  for  the  so-called  Ungraded  Classes  of  the  public  schools. 
Our  criticism  of  such  work  as  is  done  by  the  Department  of  Education  of 
New  York  City  is  that  the  examinations  and  tests  of  the  children  have 
not  been  under  adequate  medical  direction,  and  that  the  equipment  and 
organization  are  insufficient.  A  further  criticism  of  the  care  of  children 
by  the  Department  of  Education  is  the  lack  of  provision  for  the  morally 
defective. 

We  believe  that  the  Department  of  Charities  of  New  York  City  is  not 
a  suitable  department  of  City  government  to  take  upon  itself  the  permanent 
control  of  the  great  problem  of  the  feeble  minded,  in  spite  of  the  fact  that 
at  present  many  of  such  cases  come  upon  the  city  as  public  charges  and 
although  under  existing  conditions  there  is  a  legitimate  field  for  the 
activities  of  this  Department. 

Any  thoroughgoing  reorganization  of  the  care  of  the  feeble  minded  and 
the  protection  of  the  State  from  their  incapacity  or  criminal  tendencies 
should  contemplate: 

1.  State  rather  than  local  or  municipal  control. 

2.  A  permanent  bureau  of  life  records. 

3.  Self  support  where  possible. 

65 


4-     Segregation  and  detention  if  necessary. 

5.  Prevention  of  propagation  of  their  kind. 

6.  Organized  campaign  for  the  prevention  of  the  causes  which  lead  to 
feeble  mindedness." 

On  August  18,  191 5  the  Committee  brought  to  the  attention 
of  the  Constitutional  Convention  the  need  of  formulating  a  definite 
policy  for  dealing  with  mental  deficiency  and  of  amending  the 
constitution  in  a  manner  which  will  allow  the  adoption  of  such  a 
policy.  The  Committee  advocated  the  establishment  of  a  Central 
Board  of  Control,  similar  to  that  recommended  by  the  English 
Royal  Commission,  with  power  to  register  all  of  the  mentally  de- 
ficient of  the  State,  to  supervise  the  work  performed  by  local  au- 
thorities and  the  public  institutions  caring  for  this  class  of  the 
socially  unfit,  to  license  and  inspect  private  institutions  for  the 
mentally  defective,  to  enforce  the  provisions  of  the  law  relating 
to  their  commitment,  registration  and  protection,  and  to  ascertain 
in  a  scientific  manner  facts  which  shall  become  the  basis  of  a  com- 
prehensive method  of  dealing  with  the  problem. 


PRISON  HOSPITAL  WARDS. 

At  the  request  of  Mrs.  E.  H.  Harriman  for  an  opinion  as  to 
the  need  of  funds  to  pay  the  salaries  of  the  resident  staff  of  the 
Hospital  at  the  Workhouse  on  Blackwell's  Island,  for  whom  no 
provision  has  ever  been  made  in  the  City  Budget,  a  special  Sub- 
Committee  visited  the  Hospital  in  March,  191 5,  and  made  a  report 
on  the  conditions  existing  there  and  the  need  of  improving  the 
medical  service. 

The  following  is  a  summary  of  the  observations  made  during 
the  visit  to  the  hospital  wards  at  the  Workhouse : 

THE  WORKHOUSE  AT  BLACKWELL'S  ISLAND. 

The  Special  Committee  visited  the  Workhouse  at  Blackwell's  Island  on 
March  24,  1915.  They  were  met  by  the  Commissioner,  Dr.  Katherine  B. 
Davis,  and  were  shown  through  the  Institution  and  the  hospital  wards  by 
her  and  Warden  Fox. 

The  total  number  of  inmates  in  the  workhouse  averages  3000.  Of  this 
number,  approximately  1300  are  in  other  institutions  of  the  Department  of 

66 


Correction  because  of  lack  of  space  at  the  workhouse.  The  hospital  pro- 
visions consist  of  eight  wards,  four  for  men  and  four  for  women.  The 
wards  are  divided  as  follows :  one  for  medical  cases,  one  for  surgical 
cases,  one  for  active  syphilitic  cases  and  one  for  drug  addictions.  The 
wards  are  light,  airy  and  clean,  each  containing  about  20  beds.  The  wards 
are  always  full  and  often  are  very  much  overcrowded.  There  is  an  operat- 
ing room  where  operations  are  done  on  inmates  of  the  workhouse  and  also 
where  the  operative  work  of  the  Penitentiary  is  done.  There  is  a  room 
called  the  clinic  room  where  all  new  prisoners  are  examined  physically, 
and  where  all  cases  of  alleged  sickness  and  injury  are  examined. 

The  medical  service  consists  of  a  visiting  board  of  physicians  and  sur- 
geons and  of  a  staff  of  four  internes.  The  internes  are  supposed  to  serve 
a  year  in  periods  of  three  months.  During  the  first  three  months  the 
interne  is  a  senior  medical  student  who  receives  his  board  and  lodging. 

This  staff  of  internes  has  to  do  a  great  deal  of  routine  and  uninterest- 
ing work.  In  the  morning  they  must  make  the  rounds  of  the  wards ;  between 
0  and  II  o'clock  they  must  examine  patients  who  are  applying  for  relief 
in  the  hospital  wards,  and  from  40  to  50  patients  are  examined  every  morn- 
ing; from  II  to  I  o'clock  they  must  examine  all  the  new  male  prisoners 
arriving  each  day.  these  averaging  from  15  to  30  or  40.  The  female  prison- 
ers, also  about  40  a  day,  are  examined  by  a  woman  physician  who  is  espe- 
cially paid  for  this  service,  but  the  male  prisoners  must  be  examined  by  the 
staff  of  internes.  In  the  afternoon  the  staff  must  attend  to  the  operative 
work  and  make  its  rounds  again.  Owing  to  the  lack  of  pay  and  the 
monotonous  and  routine  character  of  a  large  amount  of  the  work,  it  is 
extremely  difficult  to  get  physicians  on  the  service.  We  have  been  told 
that  since  December,  1914,  there  have  been  six  new  physicians  on  the  staff 
of  internes.  Also,  these  physicians  are  not  very  amenable  to  discipline,  and 
if  much  fault  is  found  with  them  they  resign. 

There  are  one  or  two  trained  nurses  m  connection  with  the  wards,  but 
most  of  the  nurses  are  trained  attendants. 

It  was  thought  by  Dr.  Davis  that  if  there  were  enough  money  to  pay 
the  staff  as  follows :  the  first  three  months,  nothing ;  the  second  three 
months,  $25;  the  third  three  months,  $25;  and  the  fourth  three  months,  $50; 
competent  medical  service  could  be  secured.  The  Board  of  Estimate  re- 
fused to  appropriate  any  money  this  year.  The  total  money  needed  for  the 
whole  year  under  this  plan  would  be  $900.  The  Committee  is  very  de- 
cidedly of  the  opinion  that  the  medical  and  surgical  service  at  the  work- 
house should  be  made  more  attractive  in  order  to  secure  competent  medical 
help.  The  value  of  the  service  might  be  increased  by  the  appointment  of  a 
medical  superintendent  who  could  organize  the  service  and  have  it  con- 
ducted upon  regular  hospital  methods.  Until  this  is  done  there  is  no  other 
way  of  supplying  the  service  with  properly  equipped  ohysicians  than  by 
paying  the  staff  of  internes  for  their  work,  and  this  policy  is  recommended. 


THE  PROBLEM  OF  DRUG  ADDICTION. 

The  State  and  Federal  laws,  providing  stringent  checks  to  the 
illicit  traffic  in  habit-forming  drugs,  have  created  a  problem  of  pro- 
viding adequate  facilities  for  the  treatment  of  drug  habitues.  The 
number  of  cases  that  applied  for  treatment  at  the  various  institu- 
tions after  the  Boylan  and  Harrison  laws  went  into  effect  became 
so  large  as  to  create  a  serious  situation  for  the  City  hospitals. 
The  matter  was  brought  to  the  attention  of  the  Committee  and  an 
investigation  of  the  whole  subject  was  undertaken  and  a  number 
of  conferences  were  held  with  representatives  of  the  Courts  of 
General  and  Special  Sessions,  District  Attorney's  office,  Board  of 
Inebriety,  and  the  City  Department  of  Public  Charities,  Correction 
and  Bellevue  and  Allied  Hospitals. 

These  conferences  as  well  as  the  investigation  that  was  made 
revealed  very  plainly  that  there  is  a  lack  of  constructive  social 
policy  with  reference  to  the  problem  of  drug  addiction. 

The  investigation  made  apparent  the  fact  that  the  three  City 
hospitals  which  have  been  receiving  drug  cases,  Bellevue,  Metro- 
politan and  Kings  County  were  unable  to  handle  all  the  cases. 
The  hospital  at  the  Workhouse  has  been  similiarly  overtaxed. 

The  Committee  recommended  the  development  of  the  Farm 
Colony  for  Inebriates  at  Warwick,  New  York,  bought  by  the  City 
several  years  ago,  to  enable  that  institution  to  care  adequately  for 
the  male  cases  of  drug  addiction  committed  to  it.  The  Committee 
also  recommended  changes  in  the  present  court  procedure  with 
reference  to  commitments  and  the  adoption  of  a  uniform  method 
in  all  of  the  courts  with  reference  to  drug  addicts. 

The  need  was  pointed  out  for  the  establishment  of  a  colony 
for  female  cases  and  for  the  organization  of  a  follow-up  service 
that  would  take  care  of  all  the  discharged  patients  by  Social  Service 
workers,  would  guide  them  in  procuring  employment  and  prevent 
them  from  falling  again  into  associations  or  conditions  which  were 
responsible  for  the  development  of  their  drug  habit. 

The  Committee  also  pointed  out  the  need  of  so  amending  the 
present  law  as  to  allow  utilization  at  the  City  hospitals  of  the  drugs 
confiscated  and  taken  away  from  dishonest  dealers. 

A  law  to  this  effect  has  been  passed  by  the  Legislature. 


68 


HOMES  FOR  THE  AGED. 

At  the  request  of  the  Department  of  Health,  the  Committee 
undertook  to  ascertain  the  existing  conditions  with  reference  to 
the  medical  and  sanitary  care  of  the  inmates  in  the  Homes  for  the 
Aged.  An  analysis  of  available  reports  showed  that  the  homes 
vary  greatly  in  sanitary  conditions  and  in  the  medical  care  afforded 
to  the  inmates ;  and  in  some  of  them  conditions  appear  to  leave 
much  to  be  desired.  The  Committee  recommended  that  a  sanitary 
survey  and  more  rigid  supervision  of  these  Homes  be  made  by  the 
Department  of  Health. 


69 


VIII 


OUT-PATIENT  CLINIC5 


ASSOCIATED  OUT-PATIENT  CLINICS. 

Very  early  in  the  work  of  the  Committee  the  importance  of 
the  dispensary  in  preventive  medicine  and  in  the  public  health 
movement  was  recognized  and  special  attention  paid  to  the 
work  of  the  Associated  Out-Patient  Clinics.  It  became  apparent 
that  there  existed  a  great  discrepancy  of  standards  and  procedure 
and  little  or  no  co-operation  between  the  various  institutions.  The 
possibility  of  an  association  of  dispensaries  was  suggested  to  a  num- 
ber of  trustees  of  hospitals  and  a  call  issued  for  a  meeting  to  dis- 
cuss the  possibility  and  advisability  of  such  an  association. 

The  first  meeting  was  held  on  February  29,  1912.  It  was 
attended  by  representatives  of  26  institutions  and  the  following 
resolution  was  adopted  at  that  meeting: 

Whereas,  The  out-patient  departments  of  hospitals  and  dis- 
pensaries represented  at  this  meeting  acknowledge  their  common 
responsibility  for  the  proper  treatment  of  the  sick,  who  are  too 
poor  to  pay  for  medical  advice  and  treatment,  and  are  not  eligible 
for  hospitals,  and 

Whereas,  Their  work  hitherto  has  not  been  co-ordinated, 
neither  has  it  been  effectually  regulated  either  by  law  or  by  the 
voluntary  adoption  of  suitable  standards,  and 

Whereas,  The  volume  of  dispensary  work,  in  the  absence  of 
suitable  checks,  tends  constantly  to  increase,  while  its  quality,  in 
the  absence  of  recognized  standards  and  for  want  of  sufficient 
means,  does  not  improve  as  rapidly  as  does  the  quality  of  other 
forms  of  recognized  medical  or  other  charitable  relief: 

70 


Therefore,  be  it  Resolved,  That  the  dispensary  representa- 
tives present  favor  the  formation  of  a  co-operative  dispensary  as- 
sociation, which  shall  have  for  its  immediate  objects  the  co-ordina- 
tion of  the  work  of  the  existing  dispensary  and  out-patient  depart- 
ments in  the  City  of  New  York,  the  elimination  of  unworthy  appli- 
cants for  medical  treatment,  the  promotion  of  proper  standards 
of  treatment  and  the  furthering  of  such  changes  in  methods  as 
shall  make  for  economy  and  efficiency  in  dispensary  management; 
and 

Be  it  Further  Resolved,  That  a  Committee  of  Five,  to  be 
appointed  by  the  Chair,  be  invited  to  serve  as  a  Committee  on 
Temporary  Organization  with  power  to  add  to  their  number  as 
many  representatives  of  dispensaries  and  of  hospital  out-patient 
departments  as  may  signify  their  willingness  to  co-operate  in  this 
movement. 

As  a  result  of  the  activities  of  the  Committee  on  Temporary 
Organization  a  permanent  organization  was  established  with  the  fol- 
lowing general  aims : 

1.  The  co-ordination  of  the  work  of  existing  dispensaries  and  out- 
patient clinics, 

2.  The  elimination  of  unworthy  applicants  for  treatment, 

3.  The  promotion  of  proper  standards  of  treatment,  and 

4.  The  promotion  of  economy  and  efficiency  in  dispensary  man- 
agement. 

The  membership  of  the  Association  includes  the  most  import- 
ant clinics  of  the  City.  In  Manhattan  40  institutions  hold  mem- 
bership in  the  Association  and  the  Brooklyn  chapter  is  composed 
of  12  members.  The  work  of  the  Association  has  been  along  con- 
structive lines.  A  series  of  standards  dealing  with  equipment  and 
organization  have  been  formulated  with  painstaking  care  and  a  well- 
recognized  gap  in  the  science  of  hospital  administration  has  been 
filled. 

VENEREAL  DISEASES. 

When  in  the  Fall  of  19 12  the  Health  Department  made  a  re- 
quest of  the  Board  of  Estimate  and  Apportionment  for  funds  to 
establish   Venereal   Disease   clinics,   the    Committee   opposed    the 

71 


granting  of  this  request  on  the  ground  that  insufficient  effort  had 
been  made  to  use  the  resources  already  at  hand  and  that  there  was 
no  evidence  of  the  expediency  of  the  Department  of  Health  assum- 
ing additional  therapeutic  activities. 

The  money  was  not  granted  and  the  Committee,  realizing  the 
responsibility  it  had  assumed  and  the  urgent  need  of  improving 
the  existing  dispensary  and  hospital  facilities  for  the  treatment  of 
Venereal  Diseases  in  this  City,  arranged  for  a  public  meeting 
which  took  place  at  the  Academy  on  February  20,  1913.  At  this 
meeting  the  following  matters  were  discussed: 

The  attitude  of  the  Department  of  Health  in  relation  to  Venereal 

Diseases,  by  Dr.  Hermann  M.  Biggs. 
Dispensary  facilities  for  the  treatment  of  Syphilis,  by  Dr.  Homer 

F.  Swift. 
Adequate  dispensary  facilities  for  the  treatment  of  gonorrhea,  by 

Dr.  E.  L.  Keyes,  Jr. 
Hospital  accommodations  for  acute  Venereal  Diseases  in  New  York 

City,  by  Dr.  S.  S.  Goldwater. 
Relation   of   Syphilis  to   Internal  Medicine,  by  Dr.   Warfield  T. 

Longcope. 

The  papers  presented  at  that  meeting  were  subsequently  pub- 
lished in  book  form. 

Several  informal  conferences  followed  the  meeting,  and  at  the 
request  of  the  Committee  the  Associated  Out-Patient  Clinics  took 
up  the  study  of  Dispensary  facilities  for  the  treatment  of  Venereal 
Diseases  and  formulated  a  set  of  constructive  recommendations. 

Unfortunately  only  a  few  of  the  institutions  in  this  City  have 
lived  up  to  the  standard  recommended,  and  recently  the  Commit- 
tee has  again  endeavored  to  bring  the  matter  to  the  attention  of  the 
hospital  trustees  through  the  means  of  a  questionnaire  addressed  to 
the  hospitals  of  the  City. 

Realizing  the  need  of  a  better  control  of  Venereal  Diseases  in 
this  City,  the  Committee  unanimously  recommended  to  the  Acad- 
emy the  adoption  of  the  following  resolutions,  which,  however, 
though  endorsed  by  the  Council  of  the  Academy,  failed  of  passage. 


72 


Resolved,  That  the  New  York  Academy  of  Medicine 

1.  Is  opposed  to  the  establishment  of  a  clinic  for  the  treatment  of 
venereal  diseases  by  the  Department  of  Health  until  it  is  proved  that  the 
existing  dispensaries,  public  and  private,  cannot  be  made  adequate  to  the 
needs  of  the  city. 

2.  Approves  the  facilities  for  the  diagnosis  of  venereal  diseases  which 
the  Department  of  Health  affords  through  its  laboratories. 

3.  Is  in  favor  of  reporting  all  cases  of  gonorrhea  and  communicable 
syphilis  to  the  Department  of  Health  under  such  regulations  as  will  insure 
privacy. 

4.  Urges  action  on  the  part  of  the  general  hospitals  leading  to  the 
admission  under  suitable  precautions  of  persons  in  the  active  stage  of 
syphilitic  infection. 

5.  Urges  action  on  the  part  of  the  general  hospitals,  leading  to  the 
admission  under  suitable  precautions  of  persons  in  the  active  stage  of 
gonorrheal  infection. 

6.  Strongly  urges  upon  the  general  dispensaries  which  wish  to  treat 
syphilis,  the  absolute  necessity  of  providing  special  adequate  facilities  for 
its  diagnosis  and  treatment. 

7.  Approves  the  action  of  the  Associated  Out-Patients  Clinics  in  direct- 
ing the  formation  of  an  Association  of  Genito-Urinary  and  Syphilitic  Depart- 
ments of  general  dispensaries  in  this  City  for  the  purpose  of  co-ordinating 
and  standardizing  the  medical  and  administrative  work  in  connection  with 
venereal  diseases. 


TONSIL  AND  ADENOID  OPERATIONS. 

In  191 3  the  Committee  made  a  study  of  the  extent  and  the 
prevailing  methods  of  procedure  with  regard  to  Adenoid  and  Tonsil 
Operations  in  the  dispensaries  of  the  City  and  having  found  them 
insufficient  and  inadequate  has  referred  the  matter  to  the  Associated 
Out-Patient  Clinics  with  the  request  for  action  in  the  matter. 

The  Association  obtained  advice  from  the  Section  on  Laryn- 
gology of  the  New  York  Academy  of  Medicine  to  the  effect  that 
both  tonsillectomy  and  tonsillotomy  are  operations  requiring  the 
facilities  of  a  hospital. 

Recommendations  of  the  Association  based  on  this  opinion 
were  sent  to  the  dispensaries  of  the  City.  However,  not  many  of 
them  found  it  possible  to  change  their  previous  methods.  Conse- 
quently, in  1914  the  Committee  called  a  conference  at  which  the 
Department  of  Health,  the  Laryngological  Section  of  the  Academy, 

73 


The  Associated  Out-Patient  Clinics  and  the  State  Charities  Aid 
Association  were  represented. 

The  representative  of  the  Health  Department  explained  that 
the  inadequacy  of  the  existing  facilities  for  the  treatment  of  tonsils 
and  adenoids  as  well  as  the  unsatisfactory  methods  were  chiefly 
responsible  for  the  Department  of  Health  establishing  clinics  of  its 
own  to  treat  the  large  number  of  school  children  in  need  of  relief. 
At  this  conference  the  conclusions  of  the  report  made  by  Dr.  G.  H. 
Cocks  for  the  State  Charities  Aid  Association  were  discussed  and 
endorsed.  In  view  of  that,  the  Committee  recommended  that  oper- 
ations on  the  tonsils  be  performed  under  complete  anaesthesia; 
that  the  private  hospitals  of  the  City  be  requested  to  co-operate 
with  the  Health  Department  in  the  operative  care  of  children  with 
enlarged  tonsils  and  adenoids;  that  the  hospitals  provide  proper 
and  adequate  facilities  for  such  cases  and  that  the  City  compensate 
the  hospitals  for  this  special  service;  and  further  that  the  public 
hospitals  be  requested  to  provide  similar  facilities  without  special 
compensation.  As  a  result  of  the  pressure  brought  to  bear  upon 
the  dispensaries,  conditions  have  improved  in  some  instances  and 
the  Committee  felt  justified  in  endorsing  the  action  of  the  De- 
partment of  Health  in  discontinuing  these  five  special  nose  and 
throat  clinics  after  January  i,  1916. 

It  is  the  opinion  of  the  Committee  that  the  functions  of  the 
Department  of  Health  should  be  restricted  to  the  prevention  of 
diseases  and  that  no  therapeutic  activities  should  be  carried  on  in 
the  Department. 


74 


IX 


HEALTH  PROTECTION  OF  THE  PORT 
OF  NEW  YORK 


QUARANTINE. 


In  1912,  during  the  State  inquiry  into  the  management  of  the 
quarantine  Station  at  Rosebank,  the  Committee  undertook  an  in- 
vestigation of  the  problem  in  its  broader  bearings.  Upon  ex- 
amination of  the  existing  literature  on  the  subject,  the  Committee 
was  struck  by  the  scarcity  of  material  relating  to  the  history  of 
quarantine  development  in  this  country  as  well  as  with  reference 
to  the  problem  of  quarantine  administration.  Extept  in  1892  when 
the  port  was  threatened  with  cholera  and  committees  of  the  New 
York  Chamber  of  Commerce  and  of  the  New  York  Academy  of 
Medicine  were  appointed  to  advise  with  reference  to  immediate 
measures  to  be  taken  to  relieve  the  grave  situation  that  existed  at 
the  time,  no  public  interest  has  been  taken  in  the  matter  of  quaran- 
tine in  the  last  two  or  three  decades. 

Realizing  that  the  matter  of  quarantine  and  its  administration 
are  matters  of  vital  importance  to  the  public  health  interests  of  the 
community,  the  Committee  made  a  study  of  the  problem  in  its  vari- 
ous relations.  The  report  contains  an  elaborate  discussion  of  the 
relative  advantages  and  disadvantages  of  Federal  and  Local  control 
of  quarantine  at  the  Port  of  New  York.  After  a  thorough  con- 
sideration of  the  various  arguments  the  Committee  reached  the 
conclusion  that  in  the  interest  of  the  City  and  State  as  well  as  the 
country  at  large  it  is  of  importance  to  effect  a  change  of  the  control 
of  the  Station  from  the  State  to  the  Federal  Government.  The 
report  was  published  in  the  Journal  of  the  American  Medical  Asso- 

75 


elation  on  January  i8,  19 13.  It  has  received  wide  and  favorable 
comment  in  the  medical,  public  health  and  lay  press  and  stirred  up 
public  opinion  to  the  realization  of  the  dangers  of  inadequate  con- 
trol which  may  result  from  exigencies  of  State  politics. 

After  the  war  broke  out  it  became  apparent  to  the  Committee 
that  some  radical  steps  should  be  taken  with  reference  to  quaran- 
tine, to  protect  the  community  from  the  possible  dangers  of  import- 
ing disease  from  the  infected  areas  of  Europe.  The  following  reso- 
lution has  been  adopted  in  April,  1915: 

Whereas,  Maritime  quarantine,  like  over-sea  commerce,  is  not  a  matter 
of  local,  but  of  national  and  international  interest  and  importance ;  and 

Whereas,  The  modern  tendency  in  quarantine  administration  all  over 
the  world  has  been  from  local  to  national  and  international  rules  and  regu- 
lations which  insure  uniformity  of  system  and  practice ;  and 

Whereas,  Quarantine  work  is  essentially  scientific  in  its  nature,  and 
cannot  be  carried  on  efficiently  unless  the  tenure  of  office  be  independent  of 
changes  in  administration  and  of  politics ;  and 

Whereas,  The  United  States  Public  Health  Service,  by  its  organization, 
the  character,  training  and  experience  of  its  personnel  and  its  opportunities 
for  constant  communication  with  all  foreign  ports,  is  admirably  equipped 
to  administer  quarantine  in  a  most  efficient  manner,  as  attested  by  the 
satisfactory  results  obtained  in  San  Francisco,  New  Orleans,  Mobile,  Manila 
and  the  50  or  more  other  stations  administered  by  the  Service  in  the  United 
States  and  its  dependencies ;  and 

Whereas,  The  history  of  local  quarantine,  including  that  of  the  port  of 
New  York,  has  shown  that  in  times  of  crisis  the  local  stations  have  been 
unable  to  cope  with  the  situation  without  the  assistance  of  the  Federal 
Government ;  and 

Whereas,  There  exists  in  Europe  at  the  present  time  wide-spread 
quarantinable  disease  which  will  become  a  source  of  grave  danger  to  this 
country  when  immigration  resumes  its  usual  course  at  the  termination  of 
the  war ;  and 

Whereas,  The  opening  of  the  Panama  Canal  will  bring  New  York  into 
direct  shipping  contact  with  South  American  and  Asiatic  countries,  thus 
increasing  the  possibilities  for  the  introduction  of  endemic  tropical  diseases ; 
and 

Whereas,  Of  all  ports  of  this  country  that  of  New  York  ranks  first  as 
a  receiving  station  for  foreign  goods  and  immigration,  as  well  as  a  dis- 
tributing center  for  the  entire  country;  and 

Whereas,  The  Federal  government  controls  all  the  services  incident  to 
the  administration  of  the  port  of  New  York  with  the  single  exception  of 
the  quarantine,  which  is  logically  a  part  of  the  immigration  service;  and 
Whereas,   The   United    States    as    a   party   to   international   quarantine 

76 


agreements  cannot  guarantee  their  uniform  observance  unless  all  quaran- 
tine stations  are  under  Federal  control ;  and 

Whereas,  The  expenses  for  health  protection,  the  benefits  of  which 
are  shared  by  all  parts  of  the  nation,  should  not  be  borne  by  one  city  or 
state ;  and 

Whereas,  All  the  ports  of  this  country  with  the  exception  of  Baltimore 
and  New  York,  for  the  reasons  above  cited  have  already  ceded  their  quaran- 
tine functions  wholly  or  in  part  to  the  Federal  government, 

Therefore  be  it  Resolved,  That  the  economical  and  efficient  administra- 
tion of  the  quarantine  service,  and  above  all  the  safeguarding  of  public 
health,  demand  the  transfer  of  the  quarantine  station  of  the  port  of  New 
York  from  the  State  to  the  National  Government ;  and 

Be  it  further  Resolved,  That  the  Governor  of  the  State  of  New  York 
be  and  hereby  is  respectfully  and  earnestly  urged  to  take  immediate  steps  to 
secure  such  transfer. 

In  order  to  find  out  the  extent  of  public  approval  of  the  policy 
advocated  by  the  Committee,  this  resolution  was  sent  to  a  large 
number  of  persons  interested  in  public  health,  such  as  citizens  of 
prominence,  educators,  men  of  large  affairs,  physicians,  social 
workers,  health  officers  and  others.  Over  i,ooo  replies  were  re- 
ceived endorsing  the  suggestion,  and  but  two  or  three  persons  ques- 
tioned its  advisability. 

Impressed  by  the  extent  of  unanimity  in  public  sentiment  with 
reference  to  this  matter,  the  Committee  took  steps  to  bring  it  to 
the  attention  of  the  Governor.  It  is  a  source  of  gratification  to  be 
able  to  record  that  the  matter  has  received  very  careful  and  sym- 
pathetic consideration  on  the  behalf  of  Governor  Whitman  who  on 
many  occasions  has  shown  an  enlightened  interest  in  public  health. 
After  having  satisfied  himself  with  the  advisability  of  making  the 
proposed  change,  the  Governor  incorporated  the  suggestion  in  his 
message  to  the  Legislature  at  the  beginning  of  the  present  year. 
Following  this  message  the  Committee  took  steps  to  have  a  bill 
introduced  in  the  Legislature  transferring  the  quarantine  station 
to  Federal  control. 

Senator  Ogden  L.  Mills  introduced  such  a  bill  in  the  Senate 
and  Mr.  Adler  introduced  the  same  bill  in  the  Assembly.  While 
the  bill  was  in  Committee  many  hundreds  of  persons  wrote  to 
Albany  urging  its  passage.  The  bill  was  favorably  reported,  passed 
both  Houses  of  the  Legislature  and  was  signed  by  the  Governor. 

Pending  the  arrangements  which  the  commission  created  by 


77 


the  bill  is  to  make  with  the  Federal  Government  concerning  the 
disposal  of  the  real  estate  and  other  property  connected  with  the 
station  at  Rosebank,  an  officer  of  the  United  States  Public  Health 
Service  has  been  appointed  by  the  Governor  and  confirmed  by  the 
Senate  to  take  charge  of  the  Station. 


PHYSICAL  AND  MENTAL  EXAMINATION  OF 
IMMIGRANTS. 

The  great  decline  in  immigration  caused  by  the  present  war 
has  suggested  to  the  Committee  the  desirability  of  establishing  a 
system  of  thorough  physical  and  mental  examination  of  the  immi- 
grants with  a  view  of  ascertaining  the  prevalence  of  various  dis- 
eases among  them.  From  a  conference  with  the  Chief  Medical 
Officer  of  Ellis  Island,  the  Committee  learned  that  such  intensive 
examinations  have  been  started  and  that  the  percentage  of  defects 
noted  has  increased  from  the  former  two  or  three  per  cent,  to 
about  seven  per  cent,  ascertained  by  this  more  careful  scrutiny. 
This  difference  of  results  obtained  suggested  the  desirability  of 
asking  the  Surgeon  General  of  the  Public  Health  Service  to  attach 
a  larger  number  of  physicians  to  the  medical  corps  at  Ellis  Island 
when  immigration  resumes  its  normal  course,  and  to  ask  the  De- 
partment of  Labor  to  increase  the  detention  facilities  at  the  immi- 
gration station. 


HARBOR  POLLUTION. 

At  the  time  the  Metropolitan  Sewerage  Commission  completed 
its  work,  in  May  1913,  the  Committee  made  a  study  of  the  avail- 
able reports  and  arranged  for  a  meeting  at  the  Academy  on  the 
subject  at  which  the  various  problems  involved  were  discussed  by 
Dr.  Soper  and  other  members  of  the  Commission.  As  no  steps 
were  taken  by  the  City  to  relieve  the  heavy  pollution  of  the  harbor 
and  as  conditions  are  becoming  aggravated,  the  Committee  has  re- 
cently brought  this  matter  to  the  attention  of  the  Board  of  Esti- 
mate and  Apportionment  in  the  form  of  the  following  letter: 


78 


To  the  Board  of  Estimate  and 
Apportionment,  New  York  City: 

Gentlemen : — 

From  various  studies  that  have  been  made  of  the  sewage  problem  of 
this  City  it  is  evident  that  some  comprehensive  plan  must  be  adopted  in 
the  near  future  to  prevent  the  surrounding  waters  from  becoming  so  foul 
as  to  constitute  a  serious  nuisance  and  a  danger  to  health.  It  has  been 
ascertained  that  the  harbor  is  heavily  polluted  with  sewage,  that  the  organic 
matter  discharged  into  the  waters  has  drawn  heavily  upon  the  natural 
assimilative  capacity  of  the  water  and  that  tidal  action  does  not  sufficiently 
flush  out  the  harbor.  The  flushing  action  of  the  tide  is  slightest  in  the 
East  and  Harlem  Rivers  and  the  pollution  has  become  particularly  heavy 
in  these  waterways.  Tests  made  in  1913  showed  that  the  Harlem  River 
was  82  per  cent,  polluted  and  that  at  various  times  during  the  hot  weather 
there  was  practically  no  free  oxygen  in  the  water  of  the  Harlem  River. 
If  the  supply  of  oxygen  in  the  waters  surrounding  the  City  is  ever  allowed 
to  become  exhausted  the  water  will  turn  black,  offensive  gases  will  be 
given  off  and  the  harbor  will  resemble  a  huge  septic  tank. 

Without  presuming  to  advise  as  to  the  standards  of  cleanness  and  as 
to  what  would  be  the  most  practical  way  of  attacking  the  problem,  the  Com- 
mittee, after  an  inquiry  into  the  matter,  has  resolved  to  urge  upon  the 
Board  of  Estimate  and  Apportionment  the  initiation  of  immediate  steps  to 
prevent  the  further  pollution  of  the  harbor  and  the  formulation  of  plans 
for  dealing  with  this  important  problem  in  a  comprehensive  fashion. 

It  is  the  belief  of  the  Committee  that  the  initial  steps  in  a  matter  of 
such  vital  importance  to  the  health  of  the  City  should  not,  and  cannot, 
with  safety,  be  entrusted  to  local  improvement  boards  or  to  the  individual 
boroughs.  In  the  Committee's  opinion  it  is  a  City  problem  which  should  be 
dealt  with  by  the  City  as  a  whole.  In  appropriating  money  out  of  the 
general  tax  funds  some  years  ago  for  the  investigation  by  the  Metropolitan 
Sewerage  Commission,  the  Board  of  Estimate  and  Apportionment  tacitly 
accepted  the  principle  that  harbor  pollution  is  a  City  matter,  and  not  a 
matter  of  local  district  concern. 

We  respectfully  bring  this  matter  to  the  attention  of  the  Board  in  the 
hope  that  it  will  receive  early  consideration. 

Very  truly  yours, 

(Signed)  E.  H.  Lewinski-Corwin, 
Executive   Secretary. 

The  Board  of  Estimate  requested  the  Chief  Engineer  to  re- 
port on  immediate  steps  to  be  taken  to  relieve  the  situation.  The 
plans  submitted  call  for  the  construction  of  a  trunk  sewer,  by 
means  of  which  the  sewage  from  the  Bronx  and  the  northern  part 
of  Manhattan  will  be  diverted  from  the  East  and  Harlem  Rivers 


79 


to  the  Hudson  River.  There  are  also  two  other  schemes  proposed. 
The  Committee  has  held  several  conferences  with  the  Chief  Engi- 
neer of  the  Board  of  Estimate  and  Apportionment  and  with  the 
Chief  Engineer  of  Sewers  of  the  Borough  of  Manhattan.  The 
matter  is  still  receiving  the  attention  of  the  Committee. 


80 


X 


M15CLLLANLOU5  ACTIVITIL5  AND  REPORTS 


THE  FORMATION  OF  A  HEALIH  FEDERATION  OF  THE  CITY 

OF  NEW  YORK. 

In  the  course  of  the  Committee's  activities  it  became  apparent 
that  there  are  many  organizations  in  this  city  whose  work  is  similar 
in  scope  and  method  and  yet  there  is  no  endeavor  to  co-operate. 
It  occurred  to  the  Committee  that  to  save  energy  and  also  to 
bring  about  a  greater  concentration  of  effort  on  certain  matters 
it  might  be  advisable  to  form  an  organization  comprised  of  repre- 
sentatives of  the  various  civic  agencies  interested  in  public  health. 
Upon  investigation  it  was  found  that  there  are  in  this  city  over 
one  hundred  private  agencies  which  are  interested  in  various  phases 
of  public  health  work. 

The  Committee  thereupon  called  a  meeting  of  these  organiza- 
tions in  the  hope  that  such  a  conference  might  reveal  not  only 
aims  held  in  common  but  also  methods  of  co-operation.  In  par- 
ticular, it  was  thought  that  any  opinion  of  such  a  conference 
representing  the  wishes  of  so  many  organizations  would  be  wel- 
come and  effective  at  budget  hearings. 

The  response  to  the  invitation  was  encouraging  and  generous. 
At  this  gathering  held  at  the  Academy  of  Medicine  on  June  4, 
1913,  the  following  resolution  was  adopted: 

Whereas,  There  are  in  the  City  of  New  York  about  one  hundred  and 
twenty-five  private  organizations  interested  in  various  phases  of  Public 
Health  work;  and 

Whereas,  The  existing  lack  of  close  co-operation  and  co-ordination 
permit  duplication,  and  waste  of  effort  as  well  as  a  distinct  loss  in  the 
effectiveness  of  the  various  independent  endeavors, 

81 


Therefore,  be  it  Resolved,  That  a  Central  Committee  on  the  Public 
Health  of  New  York  City,  composed  of  representatives  of  the  various  or- 
ganizations, be  chosen  to  act  as  a  clearing  house  for  the  exchange  of  ideas 
and  information  and  for  the  co-ordination  of  the  varied  private  health  ac- 
tivities of  the  City  and  to  provide  for  the  Institution  of  an  Annual  Con- 
ference of  the  organizations. 

A  committee  was  elected  with  Dr.  John  H.  Finley  chairman. 
The  committee  proposed  that  the  association  be  known  as  the 
Health  Federation  of  the  City  of  New  York,  and  that  it  be  gov- 
erned by  a  board  of  fifteen  persons,  known  as  the  Central  Council 
of  Public  Health  of  the  City  of  New  York. 

The  general  aims  and  purposes  of  the  Federation  had  been 
formulated  as  follows : 

1.  To  provide  for  conferences  of  private  health  organizations. 

2.  To  act  as  a  clearing  house  for  the  exchange  of  ideas  and  in- 
formation in  reference  to  the  public  health  of  the  City. 

3.  To  co-ordinate  and  prevent  duplication  of  the  various  public 
health  activities  of  the  City. 

4.  To  promote  co-operation  in  the  investigation  and  study  of 
health  problems. 

5.  To  study  the  City  Budget  in  its  relation  to  public  health. 

6.  To  take  an  active  interest  in  the  administration  of  all  such 
branches  of  the  City  government  as  have  a  direct  bearing  on 
public  health ;  and, 

7.  To  provide  for  a  combined  expression  of  opinion  on  matters 
relating  to  public  health. 

After  the  appointment  of  Dr.  Finley  as  Commissioner  of  Edu- 
cation of  the  State  of  New  York,  Dr.  John  H.  Huddleston  was 
president  until  his  death  on  October  30,  191 5.  The  Federation 
held  annual  meetings  devoted  to  the  consideration  of  the  municipal 
budget.  In  addition,  several  meetings  were  held  which  were  de- 
voted to  reaching  a  better  understanding  of  the  work  done  by  the 
various  organizations  and  also  to  the  consideration  of  certain 
special  and  timely  problems  such  as  fire  prevention,  and  unem- 
ployment. 

During  the  typhoid  fever  outbreak  in  this  city,  in  the  summer 
of  1913,  the  Council  of  the  Federation  decided  to  make  a  study  of 
the  epidemic  with  a  view  of  ascertaining  the  cause  of  it  and  the 

82 


degree  of  observance  of  quarantine  rules  in  the  homes  of  typhoid 
fever  patients,  and  also  to  discover  the  proportion  of  cases  which 
were  unknown  to  the  Department  of  Health,  because  of  the  failure 
of  the  physicians  to  report. 

Twelve  sections  of  the  city  were  selected  for  a  house  to  house 
canvas  by  trained  nurses,  loaned  for  this  work  by  the  Henry  Street 
Settlement  and  by  the  Department  of  Social  Welfare  of  the  New 
York  Association  for  Improving  of  the  Condition  of  the  Poor.  A 
report  based  upon  results  of  this  investigation  was  prepared  and 
published  in  the  Nezv  York  Medical  Record,  January  lo,  1914. 
The  numerous  practical  recommendations  made  by  the  Council 
proved  of  great  service  to  the  Department  of  Health  in  focusing 
attention  upon  the  matter  of  typhoid  prevalence  in  this  City. 


OPINION  WITH  REFERENCE  TO  TYPHOID 
IMMUNIZATION. 

During  the  Typhoid  Fever  epidemic  in  Manhattan  in  19 13  the 
Committee  considered  it  its  duty  to  advise  the  public  with  reference 
to  typhoid  immunization,  and  the  following  resolution  of  the  Com- 
mittee endorsed  by  the  Academy  has  been  published  in  the  lay  press 
of  the  City: 

Whereas,  An  epidemic  of  typhoid  fever  has  been  in  active 
existence  during  two  months  of  the  fall  of  1913  in  the  Borough 
of  Manhattan  of  the  City  of  New  York;  and 

Whereas,  Immunization  against  typhoid  fever  by  the  injection 
of  typhoid  vaccine  has  become  medically  recognized  as  a  prophy- 
lactic measure  of  great  value ;  and 

Whereas,  The  Department  of  Health  of  the  City  of  New 
York  now  holds  itself  ready  to  perform  immunization  on  request. 

Be  it  Therefore  Resolved,  That  The  New  York  Academy 
of  Medicine  recommend  this  method  of  prevention  of  the  disease 
to  the  attention  of  the  public  and  urge  that  all  persons  in  an  in- 
fected family  and  any  persons  who  have  been  exposed  in  any  way 
to  the  disease  follow  up  the  sanitary  precautions  usually  taken  in 
such  cases  by  subjecting  themselves  to  immunization  at  the  hands 
either  of  their  private  physician  or  of  the  Department  of  Health. 

83 


RESUSCITATION  OF  THE  APPARENTLY  DROWNED. 

At  the  request  of  the  U.  S.  Volunteer  Life  Saving  Corps,  the 
Committee  made  inquiries  as  to  the  best  method  of  resuscitating 
the  apparently  drowned.  Opinions  were  secured  from  Prof.  W.  B. 
Cannon  of  the  Department  of  Physiology  of  Harvard  University, 
Prof.  Frederick  S.  Lee  of  the  Department  of  Physiology  of 
Columbia  University,  and  Prof.  Graham  Lusk  of  the  Department  of 
Physiology  of  Cornell  University. 

The  information  received  very  strongly  favored  the  so-called 
Schaefer  method.  The  following  is  the  information  given  to  the 
U.  S.  Volunteer  Service,  based  on  the  opinions  received  from  the 
three  sources  above  quoted :  The  Schaefer  method  is  far  prefer- 
able to  the  Sylvester  method,  and  the  Committee  heartily  approves 
its  adoption.    The  advantages  of  the  Schaefer  method  are : 

1.  It  is  very  efficient.  To  prove  this  it  is  only  necessary  to 
quote  the  results  of  careful  measurements  made  under  Schaefer's 
direction.  In  a  series  of  experiments  on  the  relative  efficiency  of 
different  methods  of  respiration,  he  found  the  air  exchange  per 
minute  to  be  as  follows :  Natural  respiration  5850  cc ;  artificial 
respiration  by  Sylvester  method  2280  cc;  artificial  respiration  by 
Schaefer  method,  6760  cc.  This  shows  that  by  the  Schaefer 
method,  exchange  of  air  is  three  times  the  amount  by  the  Sylvester, 
and  considerably  greater  than  even  in  natural  respiration. 

2.  It  can  be  performed  without  fatigue  by  a  single  individual 
for  hours.  The  ease  of  application  is  considerably  greater  than 
in  the  other  method. 

3.  It  is  simple  and  easily  learned.  It  can  be  taught  to  laymen 
in  a  few  minutes. 

4.  Its  employment  is  less  liable  to  result  in  fracture  of  the 
ribs  than  in  the  employment  of  the  other  method,  and 

5.  It  gives  complete  ventilation  of  the  lungs,  and  thus  it 
prevents  the  falling  back  of  the  tongue  into  the  respiratory  pas- 
sages. It  allows  the  tongue  to  fall  forward,  and  the  mucus  and 
water  to  escape  from  the  mouth,  so  that  the  tendency  of  this  to 
block  to  passage  of  air,  which  is  inherent  in  a  supine  method,  is 
altogether  obviated. 


84 


RESTRICTIONS  OF  THE  SALE  OF  HABIT-FORMING 

DRUGS. 

In  1913  the  District  Attorney  of  the  County  of  New  York 
pointed  out  the  difficulty  of  controlling  the  illicit  sale  of  drugs  with- 
out an  amendment  to  the  law  which  would  put  certain  control  over 
the  dispensation  of  drugs  by  physicians.  The  bill  tentatively  pre- 
pared by  the  office  of  the  District  Attorney  has  been  submitted  to 
the  Committee  for  criticism. 

After  numerous  conferences  with  the  Assistant  District  At- 
torney, with  the  representatives  of  the  Comitia  Minora  and  with 
the  Committee  on  Legislation  of  the  New  York  County  Medical 
Society,  with  representatives  of  the  State  Medical  Society  and  the 
Section  on  Laryngology  of  the  Academy  as  well  as  with  represent- 
atives of  the  College  of  Pharmacy,  the  Committee  agreed  on  the 
inclusion  in  the  law  of  certain  regulative  provisions.  The  Com- 
mittee felt  that  physicians  should  be  willing  to  submit  to  the  incon- 
veniences placed  upon  them  by  the  proposed  law,  such  as  detailed 
record-keeping,  in  order  to  afford  to  the  State  the  protection  re- 
quired from  the  evils  following  in  the  wake  of  the  promiscuous  sale 
and  use  of  habit-forming  drugs. 

QUACK  TREATMENT  AND  PATENT  MEDICINE 
ADVERTISEMENTS. 

The  Committee  was  instrumental  in  bringing  about  the  adop- 
tion by  the  Board  of  Aldermen  of  a  City  ordinance  forbidding 
misrepresentation  in  advertisements  and  making  it  a  misdemeanor 
to  advertise  the  sale  of  merchandise  or  personal  service  which  is 
deceptive  or  misleading.  The  Committee's  special  reason  for  sup- 
porting this  ordinance  was  to  discountenance  the  practice  of  dis- 
honest physicians  and  the  sale  of  harmful  drugs.  The  ordinance 
is,  however,  insufficient  to  protect  the  public  and  the  Committee 
has  therefore  given  its  support  to  the  Health  Department  ordinance 
demanding  the  printing  of  a  description  of  all  the  ingredients  of 
the  various  patent  medicines,  and  endorsed  the  so-called  Hamilton- 


85 


Fertig  bill  introduced  in  the  State  Legislature  during  1912  Session 
which  aimed  at  extending  the  principle  of  the  City  ordinance  to 
the  State. 


TWILIGHT  SLEEP. 

Twilight  sleep  was  a  matter  of  inquiry  on  the  part  of  the 
Committee.  Opinions  were  obtained  from  a  number  of  obste- 
tricians and  gynecologists  and  a  report  on  the  subject  prepared, 
which  was,  however,  never  made  public  because  of  the  still  exist- 
ing difference  of  opinion  among  obstetricians  and  gynecologists  as 
to  the  value  of  the  drug  used  and  the  methods  pursued. 


VACCINATION. 

(a)  At  the  request  of  the  Citizens'  Union  of  New  York  the 
Committee  very  carefully  considered  the  Bill  introduced  in  the 
Legislature  during  the  191 5  session,  modifying  the  existing  law 
with  reference  to  vaccination  in  several  aspects.  One  of  the 
striking  features  of  the  bill  was  its  provision  that  no  requirement 
of  vaccination  certificate  be  made  of  children  entering  public 
schools,  and  made  no  exemption  for  the  cities  of  the  first  and  second 
classes. 

The  Committee  was  very  much  opposed  to  the  principle  of  the 
bill  but,  apprised  of  the  peculiar  conditions  prevailing  in  the  rural 
sections  of  the  State,  did  not  oppose  the  bill  except  to  insist  upon 
an  amendment  exempting  the  City  of  New  York  from  its  pro- 
visions. The  following  is  the  resolution  adopted  and  forwarded  to 
the  Citizen's  Union. 

Resolved,  That  the  Public  Health  Committee  of  the  New  York  Academy 
of  Medicine  opposes  Assembly  Bill,  Int.  No.  125,  entitled  "An  Act,  to  amend 
the  public  health  law  in  relation  to  vaccination,"  in  so  far  as  it  applies  to 
New  York  City,  for  the  reason  that  present  conditions  in  regard  to  vaccina- 
tion and  the  control  of  smallpox  appear  to  be  entirely  satisfactory  in  this 
City  at  the  present  time,  and  therefore  should  not  be  changed. 


86 


(b)  At  the  request  of  the  State  Department  of  Health  the 
Committee  carefully  considered  a  circular  letter  of  instruction  pre- 
pared by  the  State  Department  of  Health  and  intended  to  guide 
physicians  in  the  performance  of  vaccination.  The  Committee 
made  a  number  of  suggestions,  some  of  which  were  adopted. 

(c)  The  Health  authorities  of  the  City  have  called  the  atten- 
tion of  the  Committee  to  the  fact  that  there  is  a  generally  imperfect 
practice  of  vaccination  among  physicians.  The  Committee  made  an 
inquiry  of  the  medical  schools  of  this  City  with  reference  to  the 
matter  and  found  that  all  of  the  colleges  give  a  certain  amount 
of  theoretical  instruction  in  vaccination.  The  Committee  felt  that 
the  theoretical  instruction  should  be  supplemented  by  more  practical 
experience  than  has  been  hitherto  afforded  to  students,  and  made 
such  a  recommendation  to  the  medical  schools  of  the  City,  advis- 
ing them  to  give  more  opportunity  to  their  students  for  practical 
work  in  vaccination  under  adequate  supervision. 


FREE  DIAGNOSIS  OF  SUSPECTED  CANCER  TISSUE. 

In  November,  191 5,  the  Commissioner  of  Health  of  the  City 
asked  the  advice  of  the  Committee  as  to  whether  the  Department  of 
Health  should  add  to  the  list  of  diagnostic  services  offered  for 
public  benefit  free  diagnosis  of  suspected  cancer  tissue.  The  Com- 
missioner stated  that  an  appeal  for  the  establishment  of  such  a 
service  has  been  made  by  the  American  Society  for  the  Control 
of  Cancer. 

Before  offering  an  opinion  on  the  matter  the  Committee  made 
an  investigation  regarding  the  existing  facilities  for  laboratory  diag- 
nosis of  cancer  in  this  City.    It  was  found : 

1.  That  there  are  three  private  laboratories  which  do  this  kind 
of  work. 

2.  That  there  are  four  medical  school  laboratories  whose 
pathologists  examine  specimens  both  free  of  charge  and  for  pay. 

3.  In  addition  there  are  24  hospitals  where  work  of  this  kind 
is  done  but  limited  to  hospital  and  dispensary  patients  and  prob- 
ably also  for  the  attending  physicians. 

4.  Then  there  is  the  State  Institute  for  study  of  malignant 

87 


diseases  at  Buffalo  which  does  work  of  this  kind  gratuitously. 
The  work  of  the  Institute  covering  the  whole  State  is  unavoid- 
ably delayed  in  some  instances. 

The  Committee  felt  that  the  stimulus  offered  to  physicians  by 
the  establishment  of  ample  facilities  for  the  analysis  of  cancer 
specimens  is  so  important  from  a  public  health  as  well  as  a  medical 
point  of  view  that  the  City  should  establish  a  special  branch  in  its 
laboratory  and  afford  to  the  practitioners  the  opportunity  for  ex- 
amination of  these  specimens  without  cost,  under  certain  safe- 
guards. 

The  following  is  the  summary  of  the  Committee's  attitude  con- 
cerning the  matter  and  its  recommendations. 

1.  Since  the  present  facilities  for  obtaining  free  diagnosis  of  suspected 
cancer  tissue  are  limited  to  the  gratuitous  work  of  the  pathologists  of  the 
various  medical  schools,  and  to  the  State  Institute  for  the  study  of  malig- 
nant disease  at  Buffalo,  the  establishment  of  such  a  service  by  the  City  De- 
partment of  Health  is  highly  desirable  and  would  be  of  value  in  promot- 
ing the  early  diagnosis  of  cancer  and  in  encouraging  practitioners  not  to 
temporize  with  new  growths  of  doubtful  nature. 

2.  Such  a  service  should,  however,  be  safeguarded  in  all  possible  ways, 
tb^  prevent  its  abuse  to  the  detriment  either  of  the  patient  or  of  the  pro- 
fession. With  this  end  in  view  specimens  of  tissue  submitted  should  be 
accompanied  by  a  written  declaration  from  the  physician  to  the  effect  that 
the  patient's  circumstances  do  not  permit  of  the  payment  of  a  fee  for 
the  examination.  Furthermore,  specimens  should  not  be  sent  directly  by  the 
practitioner,  but  should  be  brought  to  the  laboratory  by  the  patient  or  one 
of  the  patient's  family  or  friends,  who  should  there  receive  a  printed  form 
stating  the  fact  that  the  examination  is  made  without  charge;  or  what  is 
preferable,  that  specimens  may  be  sent  directly  by  the  physician,  but  the 
laboratory  should  then  send  a  statement  to  the  patient  to  the  effect  that  the 
examination  is  made  without  charge. 

3.  To  prevent  over-burdening  of  the  laboratory,  it  is  suggested  that  in 
announcing  the  inauguration  of  the  service,  attention  be  called  to  the  fact 
that  it  is  limited  to  residents  of  the  City  of  New  York  and  that  practitioners 
be  urged  not  to  make  demands  upon  it  unnecessarily. 

4.  Report  should  be  made  to  the  physician  in  the  case 

The  recommendations  of  the  Committee  were  adopted  by  the 
Department  of  Health. 

CO-OPERATION  WITH  THE  POLICE  DEPARTMENT. 

The  Committee  has  considered  with  great  interest  the  sug- 
gestion of  Police  Commissioner  Woods,  that  the  members  of  the 
Police  Force  could  be  made  efficient  agents  towards  the  promotion 

88 


of  public  health  and  street  sanitation.  A  number  of  conferences 
with  the  Commissioners  of  Police  and  Health  and  representatives 
of  various  civic  organizations  has  been  held.  In  addition,  a  num- 
ber of  the  Committee  made  a  personal  tour  of  inspection  of  Police 
Headquarters  and  certain  representative  districts  of  the  City.  This 
tour  was  personally  directed  by  Commissioner  Woods  and  resulted 
in  a  very  much  better  appreciation  of  the  problem  involved,  on 
both  sides. 

CO-OPERATION  WITH  THE  MUNICIPAL  CIVIL 
SERVICE  COMMISSION. 

At  the  request  of  the  Municipal  Civil  Service  Commission  the 
Committee  has  prepared  standards  for  physical  examinations 
for  the  position  of  clerk,  second  grade ;  has  advised  with  the  Com- 
mission in  preparing  standards  for  the  position  of  resident  physi- 
cian in  the  City  hospitals ;  has  criticized  the  standards  set  by  one  of 
the  expert  examiners  for  the  position  of  coroner's  physician  and 
has  rendered  a  detailed  opinion  thereon;  has  examined  and  critic- 
ized a  plan  for  the  reorganization  of  the  Bureau  of  Physical  Ex- 
amination of  the  Municipal  Civil  Service  Commission  and  has, 
from  time  to  time,  given  to  the  Commission  the  names  of  those 
whom  it  considered  best  qualified  to  act  as  expert  examiners  for 
the  purpose  of  rating  experience  papers,  preparing  the  examination 
and  rating  the  answers  of  candidates  for  various  important  posi- 
tions. 

In  appreciation  of  the  service  of  the  Committee,  the  Munici- 
pal Civil  Service  Commission  has,  at  its  meeting  on  July  15,  1914, 
passed  the  following  resolutions : 

Whereas,  The  Public  Health  Committee  of  the  Academy  of 
Medicine  has  rendered  the  Municipal  Civil  Service  Commission  of 
New  York  valuable  co-operation,  therefore,  be  it 

Resolved,  That  the  Municipal  Civil  Service  Commission  of 
New  York  hereby  records  its  grateful  acknowledgment  and  appre- 
ciation of  the  service  which  have  thus  been  rendered  at  a  personal 
sacrifice ;  and  be  it  further. 

Resolved,  That  these  resolutions  be  noted  on  the  minutes  of 
the  Commission  and  a  copy  thereof  forwarded  to  the  said  Com- 
mittee. 

89 


XI 


MUNICIPAL  BUDGET 


MUNICIPAL  BUDGET. 

One  of  the  aims  of  the  Committee  has  been  the  constructive 
study  of  the  budgets  of  those  of  the  City  Departments  whose 
work  deals  directly  or  indirectly  with  public  health.  Accordingly 
every  year  a  study  of  the  needs  of  the  various  Departments  is 
being  made  with  a  view  of  advising  and  assisting  the  heads  of  the 
departments  and  the  City  authorities  as  to  the  desirability  of 
changes  or  additions  in  the  established  lines  of  work. 

1911 

In  191 1  the  Committee  was  chiefly  interested  in  the  contagious 
disease  hospitals  of  the  City  and  upon  the  basis  of  a  study  made, 
a  summary  of  which  was  given  above,  it  made  certain  recommenda- 
tions to  the  Health  Department  and  to  the  Board  of  Estimate  and 
Apportionment.  It  also  urged  the  appropriation  of  funds  for  the 
construction  of  two  new  hospitals,  one  in  the  Bronx  and  one  in 
Queens. 

1912 

In  1912  the  chief  studies  of  the  Committee  in  relation  to  the 
Department  of  Health  were  in  connection  with  the  Division  of 
Child  Hygiene  and  the  Bureau  of  Records.  A  number  of  other 
items  in  the  budget  were  also  taken  up.  The  Committee  urged 
upon  the  Health  Department  the  preparation  of  Budget  requests 
for  personal  service  in  many  of  the  divisions  of  the  Department 
on  a  population  basis.  The  suggestion  was  adopted,  particularly  in 
school  inspection  work  and  in  the  control  of  contagious  diseases. 

In  the  Division  of  Child  Hygiene  the  ratio  of  physicians  and 

90 


nurses  to  school  children  in  medical  inspection  work  was  found 
to  be  too  low  and  the  Committee  recommended  an  increase  in  ac- 
cordance with  the  standard  which  it  formulated  on  the  basis  of 
minute  studies  of  the  work  and  duties  of  the  physicians  and  nurses. 
Similarly,  it  was  found  that  the  staff  of  the  Bureau  of  Records 
was  entirely  inadequate  to  allow  for  any  extension  of  the  work 
of  the  Division  in  the  direction  of  statistical  research  and  the  en- 
largement of  the  number  of  tables  published  by  the  Bureau. 

The  Committee  recommended  the  establishment  of  dental 
clinics  and  supported  the  budget  requests  of  the  Health  Depart- 
ment for  the  equipment  and  operation  of  these  clinics. 

The  Committee  urged  the  granting  of  the  request  of  the  De- 
partment of  Health  for  the  employment  of  physicians  and  nurses 
to  be  used  in  the  control  of  venereal  diseases.  The  requests  for 
the  establishment  of  clinics  for  the  treatment  of  venereal  diseases, 
however,  was  opposed  on  the  ground  that  there  was  no  evidence 
at  the  time  to  show  that  sufficient  effort  had  been  made  to  use 
the  resources  already  at  hand  and  that  there  was  also  no  evidence 
as  to  the  expediency  of  the  Health  Department  assuming  any  addi- 
tional therapeutic  activities. 

The  Committee  has  consistently  advocated  the  extension  of 
milk  stations  over  the  City,  particularly  in  congested  districts  and 
in  districts  where  the  infant  mortality  was  particularly  high. 

The  Committee  opposed  the  request  of  the  Department  for  an 
increase  in  the  number  of  inspectors  in  the  Division  of  Milk  In- 
spection on  the  ground  that  the  method  of  milk  inspection  by 
itinerant  inspectors  was  not  as  effective  as  the  bacteriological  ex- 
amination of  milk  when  delivered  to  the  City. 

The  Committee  opposed  the  budget  requests  of  the  Division 
of  Contagious  Diseases,  recommending  an  increase  in  the  number 
of  nurses  and  a  decrease  in  the  number  of  new  physicians,  on  the 
ground  that  a  great  deal  of  routine  work  in  the  home  quarantine  of 
contagious  disease  cases  could  be  done  efficiently  by  nurses  at  a 
lower  cost  to  the  City. 

With  regard  to  the  Department  of  Public  Charities  the  only 
study  undertaken  in  connection  with  the  work  of  that  Department 
was  the  investigation  of  the  need  of  a  hospital  in  the  lower  section 
of  Manhattan.  On  the  basis  of  this  investigation  the  Committee 
felt  that  there  was  no  need  for  a  hospital  in  that  Section  of  the 

91 


City  and  suggested  that  instead  an  emergency  station  be  organized 
in  connection  with  Bellevue  Hospital,  which,  as  is  well  known, 
carries  on  a  very  active  service. 

The  Committee  made  a  study  of  the  distribution  of  the  nurs- 
ing staff  at  Bellevue  Hospital  and  found  that  the  charge  that  an 
undue  number  of  nurses  was  assigned  to  duties  other  than  nursing 
was  unsubstantiated.  The  Committee  found  that  some  of  the  wards 
were  undermanned,  but  that  this  was  due  to  a  lack  of  available 
funds  for  a  sufficiently  large  nursing  staff. 

1913 

In  the  budget  of  the  Department  of  Education  the  Committee 
supported  the  request  for  three  physicians  to  be  attached  to  the 
Division  of  Physical  Training,  a  physician  for  the  open  air  classes 
which  are  designed  for  anemic  children,  and  two  physicians  for 
school  hygiene  work  in  the  Department.  Five  of  these  physicians 
were  granted  after  several  presentations  by  the  Committee. 

In  1913  the  Committee  again  reiterated  its  belief  in  the  need 
of  increasing  the  staff  of  the  Division  of  Child  Hygiene  for  school 
inspection  work  and  for  the  operation  of  dental  clinics;  also  for 
an  increase  in  the  staff  of  the  Bureau  of  Records. 

The  proposal  on  the  part  of  the  Board  of  Estimate  and  Ap- 
portionment to  reduce  the  minimum  salaries  of  medical  inspectors 
of  the  Department  of  Health  was  studied,  and  the  Committee 
opposed  this  action  in  the  belief  that  such  a  reduction  would  lower 
the  standards  of  efficiency  of  the  work. 

The  Committee  similarly  opposed  the  budget  requests  of  the 
Department  of  Health  for  additional  surgeons  and  anaesthetists 
for  the  throat  clinics  operated  by  the  Department.  The  Commit- 
tee took  the  stand  that  no  extension  of  the  therapeutic  activities  of 
the  Department  of  Health  should  be  encouraged. 

With  reference  to  the  budget  of  Bellevue  and  Allied  Hospitals, 
the  Committee  supported  the  request  for  additional  nurses  and  for 
a  larger  staff  in  the  pathological  laboratory.  After  carefully  ex- 
amining the  various  recommendations  of  the  Board  of  Estimate 
Committee  on  Hospitals,  the  Committee  endorsed  the  recommen- 
dation made  for  the  establishment  of  paid  resident  internes  at 
Bellevue  Hospital. 

Because  of  the  difficulty  in  obtaining  the  desired  information 

92 


as  to  the  plans  of  the  Department  of  Public  Charities,  the  Commit- 
tee was  unable  to  take  action  with  reference  to  the  budget  of  the 
Department,  except  to  endorse  the  plan  for  a  clearing  house  for 
mentally  defectives  in  connection  with  the  institution  at  Randall's 
Island. 

1914 

During  the  budget  hearings  in  1914,  the  Committee  advocated 
the  establishment  of  additional  milk  stations  and  the  appropriation 
of  funds  for  additional  medical  inspectors  and  nurses  to  bring  the 
ratio  of  children  to  physicians  and  nurses  nearer  to  the  standards 
set  for  school  inspection  work. 

The  Committee  endorsed  the  requests  of  the  Department  of 
Bellevue  and  Allied  Hospitals,  which  were  drawn  in  accordance 
with  recommendations  of  the  Committee  on  Hospital  Inquiry  of 
the  Board  of  Estimate  and  Apportionment.  The  need  of  ade- 
quate funds  to  allow  for  the  employment  of  a  sufficient  number 
of  nurses  to  conform  with  the  minimum  ratios,  adopted  by  the 
Committee  on  Hospital  Inquiry,  was  urged. 

The  Committee  made  a  study  of  the  situation  with  reference 
to  the  plans  of  the  Board  of  Inebriety  and  urged  the  development 
of  the  Farm  Colony. 

1915 

There  were  numerous  constructive  changes  in  the  budget  re- 
quests of  the  Department  of  Health  as  presented  in  191 5.  The 
Committee  endorsed  all  of  the  changes  and  requests  with  one  ex- 
ception. It  strongly  advocated  the  establishment  of  two  new  milk 
stations  and  the  extension  of  the  force  of  visiting  nurses  for 
tuberculosis  cases  and  it  endorsed  the  requests  for  an  additional 
clerical  staff  to  attend  to  the  enforcement  of  the  new  patent  medi- 
cine regulations. 

The  discontinuance  of  nose  and  throat  clinics  of  the  Depart- 
ment of  Health  for  reasons  of  economy  has  met  with  the  approval 
of  the  Committee  who  consistently  discouraged  the  therapeutic  ac- 
tivities on  the  part  of  the  Department  of  Health. 

The  matter  that  met  with  the  opposition  of  the  Committee 
was  the  proposed  reduction  in  the  staff  of  the  Division  of  Labora- 
tories which  if  carried  out  would  have  made  impossible  any  re- 

93 


search  work  on  the  part  of  the  Division.  In  the  opinion  of  the 
Committee  the  research  work  of  the  City  laboratories  should  not 
be  curtailed.  The  Committee  urged  upon  the  Commissioner  the 
utilization  of  a  sufficient  amount  from  the  antitoxin  fund  to  make 
good  the  contemplated  reduction  in  the  tax-levy  appropriation.  In 
accordance  with  this  recommendation  of  the  Committee,  the  Com- 
missioner made  such  use  of  the  antitoxin  fund  and  the  Laboratory 
Division  was  able  to  continue  its  routine  as  well  as  research  work 
on  an  undiminished  scale. 

The  budget  of  the  Department  of  Public  Charities  was  care- 
fully examined  and  the  requests  for  additional  nurses  in  the  several 
hospitals  of  the  Department  to  bring  the  ratio  to  the  minimum 
standards  was  strongly  endorsed.  The  request  for  a  Deputy  Super- 
intendent to  supervise  the  children's  service  at  the  Metropolitan 
Hospital,  which  received  a  special  study  on  the  part  of  the  Com- 
mittee, was  similarly  endorsed. 

The  budget  for  the  service  on  Randall's  Island,  which  has 
undergone  a  thorough  re-organization  was  strongly  supported  by 
the  Committee,  as  was  also  the  request  for  $3,960  to  be  expended 
for  medical  examinations  at  the  Municipal  Lodging  House,  at  the 
rate  of  $4.00  a  day  per  physician. 

With  reference  to  the  budget  of  Bellevue  and  Allied  Hospitals, 
the  Committee  voted  to  support  the  request  for  additional  physi- 
cians in  the  alcoholic  and  psychopathic  service  and  a  request  for 
a  supervisor  at  Bellevue  Settlement  House  which  is  carrying  on 
very  useful  educational  work  and  which  provides  quarters  for 
women  and  girls  in  the  early  stages  of  pulmonary  tuberculosis.  In 
this  respect,  the  service  is  similar  to  that  of  the  boat  "Southfield" 
for  male  tuberculosis  patients. 

The  Committee  also  endorsed  the  request  for  the  required 
staff  for  the  conduct  of  the  Clearing  House  for  atypical  children, 
which  was  transferred  from  the  Department  of  Public  Charities 
to  Bellevue. 

The  request  for  paid  physicians  in  the  out-patient  department 
of  Gouverneur  and  Fordham  Hospitals  has  also  been  endorsed  as 
well  as  the  request  for  paid  physicians  in  the  night  tuberculosis 
and  children's  clinics  at  the  Harlem  Hospital. 


94 


XII 


LLGI5LATION 


The  Committee  has  been  interested  in  a  number  of  legislative 
projects  bearing  on  public  health  and  cognate  subjects.  In  most 
Instances  the  action  of  the  Committee  was  limited  to  expressing 
either  approval  or  disapproval  of  the  proposed  measures,  but  in 
several  instances,  as  in  the  matter  of  transferring  the  quarantine 
service  at  the  Port  of  New  York  from  State  to  Federal  control 
or  the  checking  of  the  evil  arising  from  the  consumption  of  habit 
forming  drugs,  for  example,  it  took  part  in  framing  the  bills  and  in 
soliciting  the  support  for  them  on  the  part  of  medical  and  general 
public  opinion.  The  measures  with  reference  to  which  the  Com- 
mittee expressed  an  opinion  are  as  follows: 

(Federal) 

I.  The  Owen  Bill.  At  the  time  the  so-called  Owen  Bill  was 
introduced  in  Congress,  establishing  a  Federal  Department  of 
Health,  the  Committee  took  active  interest  in  the  subject  and  made 
inquiries  of  various  public  men  in  Washington  and  elsewhere.  After 
a  thorough  consideration  of  the  matter  the  following  resolution  was 
adopted : 

"Whereas,  There  has  been  a  distinct  movement  in  the  medical 
profession  for  some  years  past  for  the  conservation  of  the  national 
health ;  and 

Whereas^  There  have  been  a  number  of  bills  introduced  in 
Congress  tending  toward  the  amalgamation  of  the  public  health 
functions  of  various  departments  of  the  United  States  Government; 

Be  it  Therefore  Resolved,  That  the  Committee  on  Public 

95 


Health,  Hospitals  and  the  Budget  of  the  Academy  recommend  to 
the  Council  of  the  Academy  that  they  urge  the  formation  of  a 
National  Department  of  Health; 

And  be  it  also  Resolved,  That  a  copy  of  this  resolution  be 
sent  to  the  President  of  the  American  Medical  Association." 

2.  The  Henry  Resolution.  In  May,  1913,  Congressman 
Henry  introduced  a  resolution  in  the  House  providing  that  Rule  10 
of  the  House  of  Representatives  be  amended  so  as  to  provide  a 
standing  committee  on  Public  Health  and  National  Quarantine  to 
which  all  proposed  legislation  affecting  the  Public  Health  shall 
be  referred  instead  of  to  the  Committee  on  Interstate  and  Foreign 
Commerce. 

The  Committee  unanimously  endorsed  this  resolution  and  sent 
copies  of  this  endorsement  to  a  number  of  representatives  of  the 
House. 

3.  The  Committee  endorsed  the  Bill,  introduced  at  the  same 
session  of  Congress,  reducing  the  tariff  duties  on  drugs  and  scien- 
tific instruments  of  precision. 

Prior  to  this  action  a  thorough  investigation  was  made  of  the 
tariff  rates  on  drugs  and  scientific  apparatus  under  the  Dingly 
(1895)  and  Payne-Aldrich  (1909)  acts. 

4.  In  reply  to  a  request  from  the  Committee  of  One  Hundred 
on  National  Health  as  to  the  lines  of  extension  of  the  health  work 
of  the  Federal  Government,  the  following  four  activities  were  sug- 
gested by  the  Committee: 

1.  Interstate  control  of  sources  of  disease  infection,  such  as 
cattle,  milk,  oysters,  shell  fish,  vegetables,  etc. 

2.  The  extension  of  the  Federal  power  over  the  quarantine 
stations  of  the  ports  of  New  York,  Boston  and  Baltimore. 

3.  The  extension  of  the  registration  area  and  the  improve- 
ment and  standardization  of  vital  statistics ;  and 

4.  The  improvement  of  the  medical  examinations  at  immi- 
gration stations,  particularly  with  reference  to  more  rigorous  physi- 
cal examinations  and  mental  tests  of  the  aliens. 

5.  Recently  the  Committee  expressed  its  disapproval  of  the 
resolution  introduced  by  Senator  Works,  limiting  the  rights  of  the 
United  States  Public  Health  Service  to  join  Medical,  Public  Health 
and  other  private  scientific  bodies. 

96 


The  following  is  the  resolution  that  was  forwarded  to  the 
Senate  Committee  on  Public  Health  and  National  Quarantine  on 
May  5,  1916: 

Whereas,  the  Joint  Resolution  introduced  by  Senator  John  D.  Works 
of  California,  in  Congress,  making  it  unlawful  for  any  officer  or  employee 
of  the  United  States  Public  Health  Service  to  be  or  to  become  a  member 
or  officer  of,  or  in  any  way  connected  with,  any  medical  or  private  health 
association  or  organization  of  any  kind,  if  passed  by  Congress,  would  limit 
the  usefulness  of  a  very  important  branch  of  government  service ;  and 

Whereas,  it  would  deprive  medical,  public  health  and  other  scientific 
bodies  of  the  benefits  derived  from  association  and  interchange  of  ideas 
with  the  officers  of  the  Public  Health  Service  who  have  contributed,  indi- 
vidually and  collectively,  much  to  the  progress  of  medical  and  public  health 
science ;  and 

Whereas,  it  would  dissociate  the  members  of  the  United  States 
Public  Health  Service  from  the  rest  of  the  medical  and  public  health 
professions  and  would  deprive  them  of  the  benefit  accruing  to  them,  as 
officers  and  administrators,  from  direct  contact  with  other  workers  in  the 
same  field  of  usefulness ;  and 

Whereas,  it  is  generally  recognized  that  government  administrative 
endeavors  can  be  most  successful  only  when  cordial  co-operation  is  given 
to  them  on  the  part  of  the  public ;  and 

Whereas,  Mr.  Works'  resolution  expressly  forbids  direct  associa- 
tion of  the  officers  of  the  United  States  Public  Health  Service  with  the 
members  of  the  medical  and  public  health  professions  as  organized  in  na- 
tional bodies  where  they  can  be  most  easily  approached  and  induced  to 
co-operate  with  and  assist  in  the  work  of  the   Service ;  and 

Whereas,  by  this  prohibition,  if  enacted  into  law,  the  public  would 
materially  suffer  by  being  deprived  of  the  advantages  that  accrue  to  public 
benefit  from  the  present  close  association  of  the  officers  of  the  United 
States   Public  Health  Service  with  scientific  associations ;  and  , 

Whereas,  the  principle  of  this  resolution  may  serve  as  an  entering 
wedge  for  encroachments  of  a  similar  nature  upon  all  other  scientific 
workers  in  government  service,  to  the  detriment  of  the  efficiency  of  govern- 
ment and  to  the  public  welfare  at  large ;  and 

Whereas,  the  statement  in  Senator  Works'  resolution  concerning  the 
aims  of  the  American  Medical  Association  is  not  correct,  for  it  omits  to 
say  that  a  main  purpose  of  the  Association  is  to  weed  out  from  the  medical 
profession  dishonest  practitioners  and  to  raise  the  standard  of  medical 
education  and  practice  in  this  country, 

Therefore,  be  it  resolved,  That  the  Committee  on  Public  Health  of  the 
New  York  Academy  of  Medicine  expresses  its  emphatic  opposition  to  the 
passage  of  the  joint  resolution  of  Senator  Works;  and 

97 


Be  it  further  resolved,  That  copies  of  this  resolution  be  sent  to  the 
members  of  the  Congressional  Committees  to  which  this  resolution  was 
referred,  and  to   the   daily  press   of   New  York   City. 

Representatives  of  the  Committee  had  an  opportunity  of  pre- 
senting the  views  of  the  Committee  to  the  Chairman  of  the  Senate 
Committee  on  Public  Health  and  National  Quarantine  in  Washing- 
ton. The  resolution  of  Mr.  Works  failed  to  receive  the  endorse- 
ment of  the  Senate. 

6.  The  Committee  approved  of  the  principle  of  the  Kern- 
McGillicuddy  bill  M^hich  provided  compensation  for  injured  em- 
ployees in  the  Federal  Government. 

(State) 

In  1912  the  Committee  urged  upon  the  Governor  the  veto  of 
the  amendment  to  the  Agricultural  law  embodied  in  Assembly  Bill 
No.  154,  which  passed  under  special  rules  and  without  discussion  in 
either  branch  of  the  Legislature,  exempting  from  punishment  any 
person  who  sells  or  exchanges  milk  actually  produced  by  a  cow  or 
dairy  which  is  a  fair  sample  of  the  milk  produced  daily  by  such 
cow  or  dairy  and  which  has  not  been  adulterated,  shall  not  be  guilty 
of  any  crime  on  account  of  the  lack  of  proper  proportion  of  food 
elements  in  the  milk.  In  the  opinion  of  the  Committee  the  law  so 
amended  would  have  materially  weakened  the  protection  afforded 
to  the  public  against  impure  and  adulterated  milk  and  would  have 
rendered  the  punishment  for  violations  of  the  law  very  difficult  if 
not  impossible.  As  a  consequence  of  the  efforts  of  this  Committee 
and  other  civic  bodies,  Governor  Dix  disapproved  of  the  measure 
and  an  attempt  to  lower  the  milk  standards  was  definitely  defeated 
in  this  State. 

1912 

The  Committee  took  active  interest  in  the  revision  of  the  City 
Charter,  attempted  during  Mayor  Gaynor's  administration.  It  op- 
posed the  abolition  of  the  Board  of  Trustees  of  Bellevue  Hospital 
and  the  substitution  of  the  Board  by  a  commissioner. 

The  Committee  advocated  the  establishment  of  a  Department 

98 


of  Hospitals,  which  would  have  under  its  jurisdiction  all  of  the 
hospitals  of  the  City  with  the  possible  exception  of  the  hospitals 
for  contagious  diseases  because  of  the  present  police  power  exer- 
cised by  them  under  the  authority  of  the  Department  of  Health. 

1913 

The  Committee  helped  the  District  Attorney  in  drafting,  and 
afterward  supported  the  bill  establishing  a  better  control  over  the 
sale  and  disposition  of  cocaine,  eucaine  and  other  habit-forming 
drugs,  which  was  presented  to  the  Legislature  and  passed. 

The  Committee  took  an  active  interest  in  the  hearings  and 
work  of  the  Commission  appointed  by  Governor  Sulzer,  in  1913, 
to  draft  recommendations  with  reference  to  the  re-organization  of 
the  State  Department  of  Health. 

1914 

In  1914  the  Committee  opposed  the  so-called  Nelson  Bill  (As- 
sembly No.  453)  prohibiting  dispensaries  from  charging  any  fees 
to  anybody  for  anything.  This  bill,  if  enacted  into  law  would 
have  proved  prejudicial  to  the  interests  of  the  sick  poor  of  the 
City,  because  it  would  have  deprived  them  of  the  possibility  of 
obtaining  medicine  at  very  low  prices.  The  measure  would  also 
have  afforded  an  opportunity  for  diminished  control  over  dis- 
pensaries. As  a  result  of  the  opposition  registered  by  the  Com- 
mittee, as  well  as  other  civic  and  medical  bodies,  the  bill  was 
defeated. 

1915 
During  the  191 5  session  of  the  Legislature,  the  Committee  was 
forced  to  oppose  several  of  the  measures  because  of  the  detri- 
mental character  of  the  proposed  legislation.  Among  these  meas- 
ures were  the  so-called  Hinman  Bills  (Assembly  No.  1600-1601- 
1602-1603)  which  provided  for  a  series  of  amendments  to  the  new 
health  law  which  has  been  considered  by  sanitarians  the  country 
over  as  one  of  tlie  most  constructive  and  progressive  health  laws. 
In  the  opinion  of  the  Committee  the  amendments  were  ill-advised 
and  particularly  at  the  time  when  the  State  Department  of  Health 
had  just  passed  through  a  period  of  re-organization  in  accordance 

99 


with  the  provisions  of  the  new  law  and  was  just  beginning  to  de- 
velop its  activities.  Owing  to  the  almost  unanimous  opposition  to 
the  bills  on  the  part  of  public  health  and  civic  bodies,  the  bills 
failed  of  passage. 

The  Committee  also  opposed  a  bill  (Assembly  No.  863)  in- 
troduced by  Mr.  Thorn,  which  intended  to  free  from  the  limita- 
tions of  medical  practice  those  engaged  in  "the  practice  of  Chris- 
tian Science  for  the  prevention  and  cure  of  disease."  The  Com- 
mittee pointed  out  that  such  an  amendment  to  the  law  would  per- 
mit the  treatment  of  contagious  diseases,  such  as  diphtheria  and 
scarlet  fever  by  persons  whose  capacity  for  diagnosis  and  knowledge 
of  the  treatment  and  means  of  limiting  the  spread  of  these  diseases 
has  not  been  submitted  to  examination,  and  are  most  doubtful.  The 
Committee  regarded  these  contemplated  amendments  to  the  law  as 
a  distinct  menace  to  public  health.    The  bill  was  lost. 

During  the  preparation  of  the  bill  abolishing  the  ofifice  of  the 
coroner,  the  Committee  gave  advice  and  help  in  drafting  some  of  the 
provisions  of  the  bill,  which  was  enacted  into  the  law  the  next 
year.  During  the  same  session  of  the  Legislature,  a  bill  was  in- 
troduced in  the  Assembly  by  Mr.  Tallet  (No.  125)  amending  the 
health  law  by  striking  out  the  provisions  for  compulsory  vaccina- 
tion of  school  children.  The  Committee  opposed  the  principle  of 
the  bill  and  its  application  to  New  York  City.  As  a  result  an 
amendment  was  made  exempting  from  the  bill,  cities  of  the  ist 
and  2nd  class.  In  the  amended  form,  the  bill  passed  and  became 
law. 

1916 

In  1916  the  Committee  took  active  steps  in  urging  upon  Gov- 
ernor Whitman  the  veto  of  the  so-called  Simpson  bill,  which  passed 
the  Legislature  and  the  purpose  of  which  was  to  deprive  the  boards 
of  health  of  the  right  possessed  by  them  to  regulate  traffic  condi- 
tions so  as  to  prevent  overcrowding  in  public  conveyances.  The 
Committee  pointed  out  that  such  a  measure  would  be  prejudicial  to 
the  public  health  interests  and  would,  moreover,  establish  a  dan- 
gerous precedent  for  further  encroachments  upon  the  jurisdiction 
and  powers  of  municipal  boards  of  health.  The  Governor  vetoed 
the  bill. 

The  Committee  supported  the  Hamilton-Fertig  bill  which  aimed 

100 


at  extending^  the  New  York  City  regulations  with  reference  to 
patent  medicines  to  the  whole  State.  The  bill  was  referred  to  the 
Public  Health  Committees  of  the  Legislature.  It  has  not  been  re- 
ported out  of  Committee. 

The  Committee  very  actively  supported  the  bill  for  the  trans- 
fer of  the  quarantine  station  at  the  port  of  New  York  from  State 
to  Federal  control  and  was  able  to  persuade  the  majority  of  the 
legislators  of  the  desirability  of  the  measure.  The  bill,  appointing 
a  Commission  to  negotiate  with  the  Federal  Government  for  the 
transfer  of  the  state  quarantine  establishment  was  passed  on  April 
19th  and  approved  by  the  Governor  on  April  27,  1916. 

(Municipal.) 
Antitoxin. 

In  1912  a  resolution  was  introduced  in  the  Board  of  AJdermen 
to  discontinue  the  free  distribution  of  antitoxin  on  the  part  of  the 
Board  of  Health.  The  Committee  appeared  before  the  Board  of 
Aldermen  and  urged  that  the  resolution  be  withdrawn. 

Deceptive  Advertising. 

The  Committee  supported  the  resolution  introduced  in  1916 
by  Alderman  Chorosh  making  it  a  misdemeanor  to  place  misleading 
or  deceptive  advertisements. 

Sanitary  Code. 

In  1912  the  Committee  called  the  attention  of  the  Commis- 
sioner of  Health  to  the  insanitary  conditions  prevailing  in  certain 
types  of  bakeries,  food  product  factories,  and  stores  where  food 
is  sold,  and  to  the  lack  of  protection  of  food  products  from  con- 
tamination, and  suggested  that  an  amendment  be  added  to  the 
Sanitary  Code,  which  would  provide  that  no  food  shall  be  offered 
for  sale,  be  displayed  or  transported  unless  adequately  protected 
from  dust,  flies,  or  other  kind  of  contamination. 

This  suggestion  was  favorably  received  by  the  Board  of 
Health  and  incorporated  into  the  Sanitary  Code.  The  Committee 
also  co-operated  with  Dr.  Lederle  in  drawing  up  regulations  for  the 
sale  of  "loose"  or  "dipped"  milk. 

101 


In  1913,  during  Dr.  Lederle's  administration  the  Committee 
suggested  that  a  clause  be  added  to  the  City  Sanitary  Code  for  the 
protection  of  food  exposed  to  contamination  by  flies  and  other 
sources.  Accordingly,  section  142  of  the  Sanitary  Code  was  amend- 
ed to  meet  the  demand.  The  Committee  was  also  responsible  for 
the  inclusion  in  the  Code  of  another  provision  regulating  the  sale 
of  bichloride  of  mercury. 

The  clause  dealing  with  this  matter  provides  that  no  person 
shall  offer  bichloride  of  mercury  for  sale  except  upon  a  written 
prescription  of  a  physician  or  veterinary,  and  that  the  tablets  be  of 
a  distinctive  form  and  color  and  labeled  "poison." 

When  in  1913  the  matter  of  granting  to  the  osteopaths  the 
right  to  sign  death  certificates  came  before  the  Board  of  Health, 
the  Committee  opposed  this  request  on  the  ground  that  such  a  grant 
of  privilege  to  the  osteopaths  would  lessen  the  qualification  re- 
quired of  those  who  sign  death  certificates  and  that  such  an  ex- 
tension of  the  right  would  tend  to  make  the  statistics  of  the  causes 
of  death  still  less  reliable  than  they  are  at  the  present  time. 

During  the  recent  revision  of  the  Sanitary  Code  the  Commit- 
tee took  an  active  interest  in  the  process  and  gave  advice  whenever 
requested  by  the  Commissioner  of  Health. 


102 


INDLX 


Accidents,  Street 53 

Adenoid  and  Tonsil  Operations 73 

Advertisements,  Patent  Medicine  and  Quack  Treatment 85 

Advertising,  Deceptive 101 

Aged,  Homes  for  the 69 

Agricultural  I^aw,  Amendment  with  reference  to  Milk 98 

Antitoxin,  (Municipal  Legislation) 101 

Associated  Out-Patient  Clinics 70 

Autopsies 57 

Bellevue  Hospital,  proposed  Abolition  of  Board  of  Trustees 98 

Bichloride  of  Mercury,  Sanitary  Code  regulating  sale 102 

Blackwell's  Island,  Workhouse  at,   (Prison  Hospital  Wards) 66 

Boards  of  Health,  Bill  regulating  overcrowding  in  public  conveyances  by  100 

Bronx,  Contagious  Disease  Hospital  in  the 13 

Budget,  Studies  1911,  1912 90 

1913 92 

1914,  1915 93 

Cancer  Tissue,  Free  Diagnosis  of  Suspected 87 

Cardiac  Cases,  Care  of 32 

Cardio-Vascular  Diseases,  Chronic 39 

Census,  New  York  State,  1915 35 

Certified  Milk 49 

Children,  Eye  Defects 22 

"          Gonorrheal  Vaginitis 25 

"         I/egislation  regarding  Vaccination 100 

Mental  Fatigue 31 

"         Municipal  Hospital 18 

"          Pavilion  at  the  Metropolitan  Hospital 19 

"          Protection  of  Health 21 

"          Standards  for  Physical  Examination 26 

Christian  Science,  Thorn  Bill  regarding 100 

Chronic  Cardio-Vascular  Diseases 39 

City  Employees,  Periodic  Physical  Examination  of 39 

Clinical  Instruction  (Fifth  Medical  (Student)  Year) 58 

Clinics,  Associated  Out-Patient 70 

Cocaine  and  Eucaine,  Legislation 99 

Committee  of  One  Hundred  on  National  Health 96 

Consolidation  of  Municipal  Hospitals 18 

Contagious  Disease  Hospitals  of  the  Citj' 9 

"                 "                 "          in  the  Bronx  and  Queens 13 

103 


Conveyances,  Simpson  Bill  regarding  passenger  regulation  by  Health 

Boards 100 

Coroners 58 

"      State  Law  Abolishing  Office  of 100 

Croton  Water,  Turbidity  of  the , 51 

Death  Certificates,  Sanitary  Code  regarding  Issue  byOsteopaths 102 

Deceptive  Advertising 101 

Defective,  Care  of  the  Mentally 64 

Degenerative  Diseases  (Chronic  Cardio-Vascular  Diseases) 39 

Dental  Education 61 

Diseases,  Occupational 38 

Dispensary  Fees,  L/egislation  regarding 99 

Drugs,  Problem  of  Addiction 68 

"      Restriction  of  the  Sale  of  Habit  Forming 85 

"      State  Legislation  regarding  Sale  of 99 

"      Tariffon 96 

Education,   Dental 61 

"             Medical 58 

"             Nursing 63 

Public  Health 56 

Employment  Certificates.. 26 

Eucaine  and  Cocaine,  Legislation 99 

Eye  Defects  in  School  Children 22 

Factories,  Standards  for  Physical  Examination  of  Children  Working  in.  26 

Fatigue,  Mental  .     .  in  School  Children 31 

Federal  Legislation  95 

Fees,  Legislation  regarding  Dispensary 99 

Fertig-Hamilton  Bill  regarding  Patent  Medicines 100 

Fifth  Medical  (student)  year 58 

Food,  Pure 48 

"      Clause  in  the  Sanitary  Code 101 

Free  Diagnosis  of  Suspected  Cancer  Tissue 87 

Gary  System 33 

Gonorrheal  Vaginitis  in  Children 25 

Habit  Forming  Drugs,  Restriction  of  Sale  of 85 

State  Legislation 99 

Hamilton-Fertig  Bill  regarding  Patent  Medicines 100 

Harbor  Pollution 78 

Health,  Conditions  in  Public  Schools 21 

"        Federation  of  the  City  of  Nevy  York 81 

"        Hinman  Bills  regarding  State  Law 99 

"        Instruction  in  Medical  Schools 56 

"        (Sickness)  Insurance 53 

of  Children 21 

"        Re-organization  of  State  Department  of 99 

Henry  Resolution,  Federal  Legislation,  Standing  Committee  on  Public 

Health  and  National  Quarantine 96 

104 


Hinman  Bills,  regarding  New  York  State  Health  Law 99 

Homes  for  the  Aged 69 

Hospitals 9 

Children's  Pavilion  at  the  Metropolitan  Hospital 19 

Consolidation  of  Municipal  Hospitals 18 

Contagious  Disease  Hospitals  for  the  Boroughs  of  the  Bronx  and 

Queens 13 

Municipal  Hospital  for  Children 18 

New  York  City  Contagious  Disease  Hospital 9 

Proposed  L/egislation  regarding  a  Department  of  Hospitals 98 

Situation  in  lyower  Manhattan 18 

Housing  Problems 42 

Immigrants,  Physical  and  Mental  Examination  of 78 

Immunization,  Typhoid 83 

Infants,  Overcrowding  in  Institutions  for 33 

Insurance,  Health  (Sickness) 53 

Kern-McGillicuddy  Bill  relating  to  Compensation  of  Federal  Employees  98 

Ivegislation,  Federal 95 

"             Municipal 101 

State 98 

Manhattan,  Hospital  Situation  in  the  l/ower  Part  of 18 

Medical  Schools,  Public  Health  Instruction  in 56 

Mental  (and  Physical)  Examination  of  Immigrants 78 

Mental  Fatigue  in  School  Children 31 

Mentally  Defective,  Care  of 64 

Metropolitan  Hospital,  Children's  Pavilion  at 19 

Milk,  Certified 49 

"     City  Sanitary  Code  regarding 101 

"     State  Ivegislation  regarding 98 

Mohansic  Lake,  Sewage  Disposal  into 52 

Morbidity  Statistics  35 

Municipal  Budget,   Studies,  1911,  1912 90 

1913 92 

1914,  1915 93 

Municipal  Civil  Service  Commission 89 

Municipal  Hospitals,  Consolidation  of 18 

for  Children 18 

Municipal  Legislation 101 

Myopia  in  School  Children 22 

National  Health,  Committee  of  One-Hundred  on 96 

Nelson  Bill  regarding  Dispensary  Fees 99 

New  Contagious  Disease  Hospitals  for  the  Boroughs  of  the  Bronx  and 

Queens 13 

New  York  City  Charter,  Revision  of 98 

New  York  City  Sewage  Problem 78 

New  York  State  Census,  1915 35 

Nursing  Education 63 

Nutrition,  Pure  Food  and  Proper 48 

Occupational  Diseases 38 

Open  Air  Classes  in  Schools 29 

Operations,  Tonsil  and  Adenoid 73 

105 


Organization  of  the  Public  Health  Committee 5 

Scope  of  the  Work 7 

Osteopaths,  Sanitary  Code  regarding 102 

Out-Patient  Clinics   Associated 70 

Overcrowding  in  Institutions  for  Infants 33 

Overcrowding  in  Public  Conveyances 100 

Owen  Bill,  Federal  Department  of  Health 95 

Patent  Medicine  and  Quack  Treatment  Advertisements 85 

Hamilton-Fertig  Bill 100 

Periodic  Physical  Examination  of  City  Employees 39 

Physical  and  Mental  Examination  of  Immigrants 78. 

Physical  Examination  of  Children  between  the  ages  of  14  and  16  years 

Working  in  Fcatories,   standards  for 26. 

Police  Department,  Co-operation  witli  88. 

Pollution  of  the  Harhor 78, 

Prison  Hospital  Wards  (Workhouse  on  Blackwell's  Island) 66 

Protection  of  the  Health  of  Children 21 

Public  Health  Instruction  in  Medical  Schools 56 

Public  Schools,  Health  Conditions  in 21 

Pure  F<  od  and  Proper  Nutrition 48 

Quack  Treatment  and  Patent  Medicine  Advertisements 85 

Quarantine 75 

State  Legislation 101 

Queens,  Contagious  Disease  Hospitals  in 13 

Regulation  of  Patent  Medicines 100 

Re-organization  of  State  Department  of  Health  99 

Resuscitation  of  the  Appa  ently  Drowned 84 

Revision  of  the  Sanitary  Code 101 

Sanitary  Aspects  of  the  Subway 52 

Sanitary  Code,   Revision  of •. 101 

Sewage  Disposal  into  Mohansic  Lake 52 

Sickness  (Health)  Insurance 53 

Simpson  Bill  regarding  Boards  of  Health  and  PuMic  Conveyances 100 

Standards  for  Physical  Examination  of  Children  between  the  ages  of  14 

and  16  years  working  in  Factories 26 

State  Health  Legislation 98 

Statistics  in  the  City  of  New  York,  Vital 34 

"    "       "     "     "         "        Morbidity 35 

Street  Accidents 53 

Street  Cleaning 42 

Student  Year  (Fifth  Medical  Year) 58 

Subway,  Sanitary  Aspects  of  the 52 

Tallett  Bill   regarding  Vaccination 100 

Tariff  on  Drugs  and  Scientific  Instruments 96 

Te.cher  Mothers 46 

Thorn  Bill  regarding  Christian  Science 100 

Tonsil  and  Adenoid  Operations 73 

Turbidity  of  the  Croton  Water 51 

Twilight  Sleep 86 

Typhoid  Immunization 83 

Vaccination 86 

"             Tallett  Bill  (State)  regarding 100 

Vaginitis,  Gonorrheal,  in  Children  ....• 25 

Venereal  Diseases 71 

Wards,  Prison  Hospital 66 

Water,  Turbidity  of  the  Croton 51 

Whooping  Cough 26 

Workhouse  on  Bl^ckwell  s  Island,  Hospital  Wards  at 66 

Work's  Resolution,  Senator 96 

106 


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